RU25686U1 - DEVICE FOR ELECTROSURGICAL LAPAROSCOPIC MANIPULATIONS USING HIGH FREQUENCY BIPOLAR CURRENT - Google Patents

Abstract

A device for electrosurgical laparoscopic manipulations using high frequency bipolar current, containing two active wire electrodes equipped with current-insulating sheaths, each of which at the proximal end ends with an electrical connector for connecting to the opposite poles of a high frequency bipolar current source, which are moved apart with a locking knob in the sagittal planes at distal ends up to 15 mm, deprived of a current-insulating sheath, characterized in that the distal con One of the active electrodes is 5 mm longer than the other, both of them are bent at an angle of 90 towards each other, which allows you to clamp a piece of tissue between the active electrodes and at a current frequency of up to 1000 MHz, voltage up to 300 V and current up to 0.5 A allow the device work in cutting mode.

Description

Device for electrosurgical laaroscopic surgery using high frequency bipolar current.

The device relates to medicine, namely to surgical endoscopy. A device is known, namely, a monopolistic wire D-electrode (in our case, a comparison was made with a J-electrode 1fuchka t. 0131.10. Manufactured by GIMMI, with a working length of 34 cm), which is used as an electrosurgical knife - desegsgor for most endoscopic laparoscopic operations . There is a huge variety of similar devices of various manufacturers, modifications and forms, but they all share one thing in common - the use of high-frequency current in monopolar mode. For the first time, such devices have been used in endosurgery, in particular for laparoscopic cholecystectomy, since 1987 (DuBois, Franse). However, when working with this device, there is a risk of developing m} {severe complications (the frequency of complications will be examined using laparoscopic cholecystectomy as the most common endoscopic operation in the last decade) associated with the use of a monopolar current mode. The most common complications include bleeding from the cystic artery (from 3.5% to 5%), as well as damage to the hepatic choledochus (up to 1.5%), the appearance of which in most cases leads to the transition to laparotomigo, and in 0.5% cases leads to death (International Congress of Paws for Joscopic Surgery 1993 Moscow p. 5-73, Russian Symposium Complications of Endoscopic Surgery Moscow-1996 p. 61-87, 5th Moscow International Congress on Endoscopic Surgery Moscow-2001 p. 130 -213). The appearance of such complications is due to the fact that when applying the monopolar mode of operation of the high-frequency current, the current passes not only in the section zone - coagulation. but in all directions around, damaging the surrounding tissue inversely with their electrical resistance (K. Fastenmeier 1990 High-frequency technology in transurethra resection. 18 th Endourological Symposimn in Munich s. 1-15). The complications caused by endosurgery using the monopolar mode of operation of the high-frequency current were devoted to a large section in MaTqpHairax 18 th findourological symposium in Munich (Munchen, 18. bis 19. oklober 1990 s. 1-15).

The technical result is to provide the possibility of laparoscopic electrosurgical procedures without complications associated with the use of a monopolar mode of operation of a high-frequency current.

A reliable result is ensured by the fact that the proposed device for paws of foscopic electrosurgical manipulations in combination with a high-frequency source of bipolar current, equipped with two active electrodes, creating a discharge of the cutting current between the active electrodes, allows electrosurgical manipulations without the risk of damage to surrounding tissues spreading in all directions, inversely proportional electrical resistance of tissues, high-frequency current, as it is when applying monop polar electrode This is possible because the proposed device consists of a nickel-plated metal tube with a diameter of 5 mm. (the diameter is determined by the diameter of the trocar), 34 cm long, inside of which there are two wire electrodes isolated from each other, the working ends of which are movable in the sagittal plane like tweezers, current-insulating

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shells at a distance of 2 cm from the end of the device, both electrodes in the distal part are bent at an angle of 90 degrees to each other, and one w of the electrodes is 5 mm shorter than the other in the working part, which allows a longer electrode in the diluted instrument 3) to capture part of the tissue, after which, when its distal part is brought into contact with the distal part of the second electrode (4), the captured portion of the tissue is clamped between} two active electrodes, which makes it possible to work with a bipolar current source th frequency dissect it only in the intended area of the cut without jeopardizing the current distribution on okrunsayuschie tissue. In the proximal part, the device ends with a working handle that carries two electric ones for connecting opposite poles of a bipolar current source. When the device is used, a current is used with a frequency of 1000 MHz, a voltage of up to 300 Volts, and a current strength of up to 0.5 A. The proposed device works in conjunction with electrosurgical equipment (in our case, the Karl Storz model 26021 bipolar current source was used).

The invention is illustrated fnguramn

In FIG. Variants of traditional monopolar electrodes. Figure 2 Scheme-drawing of the distal part of the proposed device.

In Fig. J A device for electro-energetic laparoscopic manipulations with the use of high frequency bipolar current. 4, a bipolar high frequency current source. Figure 5 Distinctive features of mono - and bipolar modes of current operation.

jjM- / fO-

The device consists of a hollow metal tube (1) 34 cm long, 5 mm in diameter, inside which there are two wire electrodes with a current-insulating coating (2). The electrode (3) has a length of 36 cm (of which 2 cm. Is the working part without a current-sheathing shell, at the end with 5 mm., A hook-deflector bent by 90 fades). The electrode (4) has a length of 35.5 cm. (Of which 1.7 cm. - the working part is also without an insulating casing, at the end with a 3 mm hook hook bent at an angle of 90 degrees. At the proximal part, the device ends with a latch, thanks to which the working distal part of the device is movable in the sagittal plane by means of a drive for longitudinal movement of the latch handle and which also carries an electrical connector for connecting a high frequency bipolar current source (see Fig. 2,3).

The maximum possible extension of the distal working part of the electrodes to each other is up to 15 mm.

The device works as follows: Through a standard 5 mm. a trocar with a closed working part, the device is inserted into the abdominal cavity. Before starting work, the electrodes (3) and (4) are maximally diluted with each other using the locking knob, maximally freeing the end section of the electrode (3) for viewing with a hook of the electrode (3), a portion of tissue is captured for desection, after which the electrodes are maximally reduced together that the captured tissue site is sandwiched between; working electrodes. When applying a high-frequency current in bipolar mode, a cutting discharge occurs only between the working parts of the electrodes, cutting the captured tissue area and not spreading to

embarrassing tissues, causing the development of embarrassment, as is often the case when using the monopolar operating mode of a high-frequency current. The fact that in the clamped state of the distal part of the device between the electrode hooks remains a distance of no more than 5 mm. tissue, which also reduces the possibility of intraoperative complications. In addition, the use of a bipolar current mode in the operation of this device allows, in comparison with monopolar, to reduce the current power consumption by an average of 5 times. (see Fig. 1-5).

Compiled by Lntyuhni K.E.

Claims (1)

Device for electrosurgical laparoscopic manipulations using high frequency bipolar current, containing two active wire electrodes equipped with current-insulating sheaths, each of which at the proximal end ends with an electrical connector for connecting to the opposite poles of a high frequency bipolar current source, which are moved apart with a locking knob in the sagittal planes at distal ends up to 15 mm, deprived of a current-insulating sheath, characterized in that the distal con One of the active electrodes is 5 mm longer than the other, both of them are bent at an angle of 90 ^o to each other, which allows you to clamp a piece of tissue between the active electrodes and at a current frequency of up to 1000 MHz, voltage up to 300 V and current up to 0.5 A allow the device to work in cutting mode.