RU173163U1 - Device for laparoscopic ureteroneocystoanastomosis with antireflux mechanism - Google Patents

Abstract

The utility model is aimed at providing simultaneous intraoperative creation of a submucosal tunnel with the ureter passing through it with laparoscopic ureteroneocystoanastamosis with an antireflux mechanism without the use of additional tools and trauma to the ureter and bladder. The specified technical result is achieved by the fact that the device is made in the form of a handle, in the inner cavity of which the rod is mounted with the possibility of its longitudinal movement, and seamlessly connected to it at an angle of 90 ° of the tube, while one end of the rod is movably connected to a rotary mechanism located in place the connection of the handle and the tube, and the second is equipped with a pin with a screw thread perpendicular to the rod with the possibility of ensuring its movement along the guide slot made on the handle and fi poking nut. A plate in the form of a gutter is placed on the inner wall of the tube, and the tube is made with an atraumatic cone-shaped working end with a slot for securing the ligature. 5 ill.

Description

The utility model relates to the field of medical technology, namely to surgery, urology, and is intended to perform laparoscopic ureteroneocystoanastomosis with an antireflux mechanism.

Ureteric stricture is a disease associated with narrowing of the inner lumen of the ureter, which can have different lengths and localizations. With obstruction of the lower parts of the ureter, ureteroneocystoanastomosis is indicated. An important step in the operation is the formation of an antireflux mechanism. This action prevents the backflow of urine from the bladder through the ureter back to the pelvis of the kidney, is the prevention of the development of chronic pyelonephritis, prevents the formation of ureterohydronephrosis and the death of the renal parenchyma.

When performing ureteroneocystoanastomosis with the formation of an antireflux mechanism, the most applicable and effective is the Barry method: using an electric knife, make two parallel cuts at a distance of 3 cm from each other, cut the adventitia and detrusor to the submucosal layer, capture the mucous membrane of the bladder in the area of the distal cut and dissect the oval a window, then form a submucosal tunnel through which the ureter is held and fix it with interrupted sutures. (Khinman F. Operational urology: Transl. From English. - M.: GEOTAR-MED, 2001., pp. 819-20).

When performing a laparoscopic ureteroneocystoanastamosis with an antireflux mechanism, technical difficulties arise at the stage of creating the submucosal tunnel and conducting the ureter along it. At the same time, the risk of damage to the walls of the ureter and bladder increases significantly, the prognosis of surgery worsens: in the early postoperative period, the likelihood of failure of the anastamosis and urinary leakage develops, in the late - the occurrence of stricture leading to repeated operations. Technical difficulties at the stage of laparoscopic ureteroneocystoanastamosis with an antireflux mechanism also lead to the need to introduce additional tools and attract assistants, a possible conversion to open surgery, and, as a result, additional trauma to the patient.

From the field of technology, specialized devices for creating a submucosal tunnel and conducting the ureter along it with laparoscopic ureteroneocystanastamosis with an antireflux mechanism have not been found.

The technical result achieved using the proposed utility model is the simultaneous intraoperative creation of a submucosal tunnel with the ureter passing through it with a laparoscopic ureteroneocystanastamosis with antireflux mechanism without the use of additional tools and trauma to the ureter and bladder.

The technical result is achieved by the fact that the device for laparoscopic ureteroneocystoanastamosis with an antireflux mechanism is made in the form of a handle, in the inner cavity of which a rod is mounted with the possibility of its longitudinal movement, and a tube seamlessly connected to it at a 90 ° angle, while one end of the rod is movably connected to a rotary a mechanism located at the junction of the handle and the tube, and the second is equipped with a pin with a screw thread perpendicular to the rod with the possibility of securing it moving along the guide slot formed in the handle and the locking nut, wherein the inner wall of the tube arranged to provide a pivot plate about its axis in the form of troughs, and a tube formed with atraumatic conical working end with a slot for fastening the ligatures.

The proposed device allows to facilitate the work of the surgical team, speeds up the operation, increases the safety of the intervention for the patient and significantly improves the immediate and long-term results of the operation.

The utility model is illustrated by drawings, where:

in FIG. 1 is a schematic illustration of a device with an open tube;

in FIG. 2 is a schematic illustration of a closed-tube device;

in FIG. 3-5 - the stages of laparoscopic ureteroneocystoanastamosis with an antireflux mechanism are schematically depicted;

in FIG. 3 - a device created under the mucous tunnel in the bladder;

in FIG. 4 - the stage of the ureter through the device - the tube is closed;

in FIG. 5 - stage of removal of the device - the tube is open, the ureter is held in the formed tunnel.

A device for laparoscopic ureteroneocystoanastomosis with an antireflux mechanism is L-shaped and consists of a handle 1 and a tube 2 monolithically connected to each other at an angle of 90 °, inside the handle 1 there is a rod 3 with the possibility of longitudinal movement relative to the handle 1, while one end of the rod 3 movably fixed with a rotary mechanism 4 located at the junction of the handle 1 and tube 2, and the second end has a pin 5 perpendicular to the rod 3, provided with a screw thread with a fixed casing nut 6, placed with the possibility of moving along the guide slot 7 on the handle 1, on the inner wall of the tube 2 is a plate 8 having the shape of a trough, the curvature of which corresponds to the curvature of the tube 2, rotatably rotated along the axis of the tube 2. The tube 2 is made with atraumatic conical working end 9
on which a slot 10 is made for fixing the ligature. Moreover, the closure of the tube 2 is ensured by turning the plate 8. The device is used to create a submucosal tunnel 11 through the proximal 12 and distal section 13 of the bladder wall and holding the ureter 14 using the ligature 15.

The proposed device operates as follows.

The device is brought into a closed tube position. To do this, the fixing nut 6 located on the pin 5 is loosened by moving the pin 5 with the rod 3 along the guide of the slot 7 in the direction of the tube 2 through the rotary mechanism 4, the plate 8 is rotated along the axis of the tube 2 until its contour is completely closed, after which the fixing nut 6 is twisted . The device is held in the abdominal cavity to the area of operation, a ligature 15 is placed on the ureter, the free end of which is fixed in the slot 10 at the end of the tube 2. Make a proximal 12 and distal sections 13 of the bladder wall. Using the atraumatic working end 9 through the proximal incision 12, a submucous tunnel 11 is created in the bladder wall to the distal incision 13, the end of the ligature 15 is removed from the incision 10. And, pulling the ligature 15, the ureter 14 is drawn along the inner lumen of the tube 2 to the level of the distal incision 13 The device is moved to the open position. To this end, actions are performed that are inverse to the process of transferring the tube to the closed position: the fixing nut 6 is loosened, moving the pin 5 with the rod 3 along the guide slot 7 in the direction from the tube 2 through the rotary mechanism 4, the plate 8 is rotated along the axis of the tube 2 until its contour opens , the fixing nut 6 is twisted. By moving along the axis of the ureter 14 from the bladder and upward, the device into the open tube 2 position is removed from the submucosal tunnel 11, while the ureter 14 remains in the submucosal tunnel 11. The device is removed from the abdominal cavity, the ureter is fixed to the bladder with sutures - laparoscopic ureteroneocystoid stomatosis the mechanism is made.

The presence of a cone-shaped working end in the device provides the ability to quickly and safely create a submucosal tunnel and minimizes trauma to the bladder wall. The slot at the end of the device allows you to fix the ligature in a predetermined position, which facilitates the stage of the ureter through the device and speeds up the operation time. At the same time, when using this device, there is no need for additional fixation of the ureter wall by surgeon tools, which also reduces injury.

Thus, the proposed device provides simultaneous intraoperative creation of a submucosal tunnel and the safe passage of the ureter along it with a laparoscopic ureteroneocystoanastamosis with an antireflux mechanism without the use of additional tools and injuries of the ureter and bladder, which facilitates the work of the surgical team, accelerates the operation and increases the safety of the intervention for the patient significantly improves the immediate and long-term results of the operation. The device has wide functionality. It can be used during operations in surgery, urology, and can be used both with open surgery techniques and using laparoscopic techniques.

Claims (1)

A device for laparoscopic ureteroneocystoanastamosis with an antireflux mechanism, made in the form of a handle, in the inner cavity of which a rod is installed with the possibility of its longitudinal movement, and a tube seamlessly connected to it at a 90 ° angle, while one end of the rod is movably connected to a rotary mechanism located in place connection of the handle and the tube, and the second is equipped with a pin with a screw thread perpendicular to the rod with the possibility of ensuring its movement along the guide slot made on the handle and fixing nut, while on the inner wall of the tube is placed with the possibility of rotation relative to its axis of the plate in the form of a gutter, and the rotary mechanism is made with the possibility of rotation of the plate along the axis of the tube until its circuit is completely closed, the tube is made with an atraumatic cone-shaped working end with a slot for securing the ligature.

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