RU2363401C1 - Wound retractor - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: wound retractor has a support with a fastener assembly, cantilever with a bolt, which is fixed to the support by one end and an additional cantilever with a bolt. The bolts are pivotally attached to the ends of the cantilevers and have end joint connections for removable hooks. The removable hooks are attached to the bolts through collet hinges and have a device for replacing hooks.

EFFECT: wider technological capabilities for the wound retractor during endocavitary operations on organs of the small pelvis and upper part of the abdominal cavity, improved quality of operation.

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Description

The invention relates to medicine, in particular to surgical instruments, and can be used in surgical operations on the organs of the upper and lower floors of the abdominal cavity.

The retractor is one of the important auxiliary tools for surgical operations with transperitoneal access. Known design of the elevator of the extender of the rib arches according to the copyright certificate No. 302111, 1971 (MKI A61B 17/02), which contains a vertical rack attached to the operating table, a horizontal console with a hinge mechanism, at the end of which a knot of a retracting hook with a nut and itself is mounted crochet. The upright has a device at the bottom that protects it from rotation around the axis.

The closest to the claimed invention, the retractor in terms of features and the achieved result is the design of the retractor according to patent No. 2147840 dated 06.16.1997 (MKI 7 A61B 17/02), which contains a vertical stand attached to the operating table with a swivel bracket and a horizontal console in the form asymmetric arc. The horizontal console with a lock on one end has a hinged mechanism in the form of a swivel cardan at the other end. The swivel gimbal includes a swivel joint for mounting the hook assembly. The introduction to the design of a horizontal console in the form of an asymmetric arc with a swivel cardan and a swinging hinge allows it to be used when the abdominal wall is moved down the patient’s axis, which is especially important for operations on the pelvic organs, rectum, bladder, uterus, etc.

The disadvantage of this retractor is that the retracting hook helps to divert the internal organs and the edge of the surgical wound of the anterior abdominal wall only along the patient's axis down. In this case, the overhanging fiber of the flanks of the pelvis and adjacent internal organs is not available for abduction. During operations on the organs of the upper floor of the abdominal cavity, the retracting hook removes only part of the liver (right lobe), and the left lobe of the liver is not accessible for abduction.

The technical result is the expansion of the technological capabilities of the use of the retractor during intracavitary operations on the pelvic organs and the upper floor of the abdominal cavity, improving the quality of operations.

The objective of the invention is to provide optimal surgical access during surgical interventions on the internal organs of the upper and lower floors of the abdominal cavity.

The task is achieved by the fact that in the retractor containing the stand attached to the operating table, a console in the form of an asymmetric arc with a swivel cardan and a swinging hinge to install the outlet hook assembly, an additional console is installed on the rack, while the multi-faceted latch on the rack is made longer placing an additional console. In addition, a cardan with a ball collet clamp is installed at the second end of the console to accommodate an additional outlet hook assembly. Moreover, the introduction to the design of the ball collet clamp allows you to change the angle of inclination of the node of the outlet hook in three axes and fix the most optimal angle. The same ball collet clamp is installed on the node of the outlet hook, which allows you to fix the hooks at a certain angle and with the required angle. In addition, the collet clamp has a device for replacing and fixing interchangeable hooks.

The introduction of an additional console with an outlet hook node allows you to remove the tissue of the liver, stomach, omentum during operations on the organs of the upper floor of the abdominal cavity, organs and fiber of the pelvis during operations on the organs of the lower floor of the abdominal cavity.

The implementation of the swinging hinge in the form of a ball collet hinge with the fixation of the selected position allows you to change the angle of installation of the mirror of the hook and absolutely adapt it to the anatomical features of the surface of the organ.

The implementation of the device for replacing and fixing the hooks with one button allows you to modify the quality of surgical access during surgery.

All the signs, together with the known ones, allow expanding the technical capabilities of the retractor and improving the quality of operations.

The invention is illustrated by drawings. Figure 1 presents a General view of the retractor; figure 2 presents the ball collet hinge with a position lock and a device for replacing hooks; figure 3 presents the hook with an open groove with a locking hole, a clamp, a tightening screw clamping collet.

The proposed retractor consists of a swivel bracket 1, mounted on the side bar of the operating table with a clamping screw 2, which securely fixes the rack 3. The rack 3 has two longitudinal flats (not shown) to prevent it from turning around its axis. The upper end of the rack has the shape of a hexagon, on which a console is mounted in the form of an asymmetric arc 4 and an additional console 5 with a ball collet hinge 6 and a position lock 7. The ball collet 6 is made integral with a cardan 8 through which a screw 9 is passed with a nut placed on it 10. At the end of the screw there is a similar ball collet with a position lock 11 and a quick change device for hooks 12. Figure 2 shows a ball collet with a position lock, which consists of a ball joint 13, a clamp collet and 14, which is securely fixed at the required angle by the clamp 15 (Fig. 3) by tightening the screw 16. A hook replacement device 17 is installed on the collet. For replacing the hook 18 has an open groove with a locking hole 19 (Fig. 3).

When performing surgery on the perineum, a rack retractor is installed on the edges of the operative wound of the anterior abdominal wall. To the bar of the operating table to the left or to the right of the patient, with the help of a clamping screw 2 (Fig. 1), a rack 3, an arch 4 is installed. An arch retractor is hooked to an arch 4 along the midline in the lower corner of the surgical wound of the anterior abdominal wall, which allows you to divert the pelvic organs (bladder, uterus, rectum, etc.). In order to improve the quality of operational access in the area of the flanks of the lower floor of the abdominal cavity to the rack 3, an additional console 5 is installed, which is fixed in the most convenient position using the hexagonal section of the rack 3. The position of the universal joint 8 is fixed by a ball collet 6 and position lock 7. Through the universal joint 8 a screw 9 is passed, on the other end of which a quick-change device for hooks 12 with a position lock 11 is fastened. Hook 18 is installed in the lower left or lower right corner of the surgical wound for denia of the overhanging edge of the retroperitoneal tissue, cecum, sigmoid colon in the area of the flanks of the lower floor of the abdominal cavity. To create a better quality of access in the depth of the operative wound during the surgical intervention, the angle of the position of the hook 18 (Fig. 2) in all planes is changed using the clamping collet 14 relative to the ball joint 13 and the position lock 11 (Fig. 1). Adjusting the depth of the hook 18 (figure 2) is solved by changing it. To replace the hook 18, the surgeon, by clicking on the replacement device 17, removes the hook and changes it to the hook of the required depth, fixing it with the locking hole 19 (figure 3) in the replacement device 17 (figure 2). If necessary, the stand 3 (figure 1) with an additional console 5, the surgeon sets on the opposite side of the operating table and the patient.

In the upper floor of the abdominal cavity, the proposed retractor allows you to divert the liver along the entire lower edge (right and left lobes), as well as the stomach and the greater omentum, changing the angle of removal of these organs during surgery, changing the location of the additional horizontal console 5, ball collet and position lock 7, which is a significant advantage compared to the retractors of previous designs.

The use of the proposed retractor will allow for optimal surgical access, improve its quality, reduce the length of the surgical incision for laparotomy and the time of surgery, anesthesia, reduce the number of intra- and postoperative complications.

Claims (1)

A retractor comprising a rack with a mounting unit, a console fixed to the rack at one end, a screw pivotally mounted on the other end of the console, and a hook assembly at the other end of the screw, characterized in that it is equipped with an additional console with a screw fixed to the rack at one end and the node of the outlet hook pivotally mounted on the other end of the additional console, and outlet hooks are fixed to the screws by means of ball collet hinges having a device for replacing the hooks.

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