Single hole laparoscopic cholecystectomy

Abstract

The application discloses a single-hole laparoscopic cholecystectomy method and relates to the technical field of laparoscopy application, S1: a patient is given general anesthesia by air insertion, a belly navel turning-over technique is used to establish an operation hole at the navel, and a single-port multi-channel puncture device is arranged; S2: a 30-degree straight laparoscope lens, a curved blood vessel clamp, a non-injury grabbing clamp, an ultrasonic knife, an electric coagulation hook and other conventional surgical instruments used in multi-hole laparoscopic cholecystectomy are used, a Cross Hand method is adopted to enter the surgical instrument, the bottom of a gallbladder is lifted by the non-injury grabbing clamp, and a gallbladder triangle is exposed. If the gallbladder triangle is shielded by liver Ⅲ or Ⅳb in this step, the visual field cannot be completely exposed, and a liver traction device needs to be used to assist in exposing the visual field of the gallbladder triangle. The application always keeps the same traction force on the liver, avoids the problem that the traction force of the liver is insufficient to cause unclear visual field with the cutting of the gallbladder being deepened, better exposes the surgical visual field of the gallbladder triangle, reduces the operation time and improves the operation safety.

Description

Technical Field

[0001] This invention relates to the field of laparoscopic application technology, specifically to a single-port laparoscopic cholecystectomy method. Background Technology

[0002] With the development of modern medicine, minimally invasive surgery has become the future of surgical procedures, and traditional multi-port laparoscopic cholecystectomy has become the preferred surgical method for treating benign gallbladder diseases. With improvements in surgical techniques and instruments, single-port laparoscopic cholecystectomy has emerged, offering advantages such as high postoperative quality of life, less pain, and lower scar-related complications. However, it also has drawbacks, including narrow intraoperative field of vision, potential instrument collisions, and a higher incidence of postoperative incisional hernias. Furthermore, it places higher demands on the surgical techniques and instruments used in single-port laparoscopic surgery.

[0003] To address the issue of limited surgical field, Navarra G pioneered the use of gallbladder suture suspension to expose the surgical field; Vargas PA additionally used an internal traction device (Endograb) during the procedure. TM To improve surgical visibility, some surgeons use various techniques, including using a single-port laparoscopic system to retract the gallbladder and expose the surgical field; the Podolsky ER technique uses additional needle forceps to retract the liver for better exposure; the Kim MK technique uses a glove port to address instrument collisions and employs a snake-shaped retractor to elevate the liver and expose the surgical field; and the Sunamak O technique uses sutures instead of surgical forceps to solve the problem of instrument collisions during surgery. However, these improvements require expensive single-port laparoscopic equipment and specialized surgical instruments, and they lack self-adaptability in exposing the surgical field, resulting in the liver still obstructing the surgeon's view later in the procedure, requiring manual adjustments. While the da Vinci single-port robotic platform can also solve the problems of instrument collisions and narrowed surgical fields, the high cost of robotic surgery remains a major obstacle to its widespread adoption.

[0004] To overcome the aforementioned deficiencies of the prior art and solve the problems existing in the background art, the technical solution of this invention only requires the use of conventional surgical instruments used in multi-port laparoscopic cholecystectomy. It employs the Cross Hand method to resolve the issue of instrument collision, and the liver traction and lifting device can gradually and adaptively increase the liver lifting height according to the depth of cholecystectomy, ensuring complete exposure of the intraoperative field of vision. Finally, the umbilical incision is sutured and reshaped using the anchoring method, reducing scar-related complications and lowering the incidence of postoperative incisional hernia. Summary of the Invention

[0005] The present invention addresses the problem that existing technical solutions are too simplistic and provides a solution that is significantly different from existing technologies. Specifically, the purpose of the present invention is to provide a single-port laparoscopic cholecystectomy method to solve the problems mentioned in the background.

[0006] To achieve the above objectives, the present invention provides the following technical solution: a single-port laparoscopic cholecystectomy method, the method comprising the following steps:

[0007] S1: After the patient is under general anesthesia via endotracheal intubation, an umbilical operating port is created using the umbilical inversion technique, and a single-port multi-channel trocar is inserted.

[0008] S2: Using standard surgical instruments for multi-port laparoscopic cholecystectomy, such as a 30° straight laparoscope, curved hemostat, non-traumatic grasping forceps, ultrasonic scalpel, and electrocoagulation hook, the cross-hand method is used to enter the surgical instruments and assess the degree of gallbladder inflammation and surrounding adhesions.

[0009] S2.1: Use non-abrasive forceps to pull up the bottom of the gallbladder to expose the Calot's triangle. If the Calot's triangle is obscured by segment III or IVb of the liver during this step, the field of vision cannot be fully exposed.

[0010] S2.2: At this time, the liver traction device is used. The tip is bluntly inserted through segment III or IVb of the liver and then through the abdominal wall. After externally pulling the liver traction device, the gallbladder triangle can be fully exposed.

[0011] S3: After the gallbladder triangle is clearly visible, use the Cross Hand technique to enter the ultrasonic scalpel and dissect the gallbladder triangle to expose the CVS;

[0012] S4: Use vascular clamps to clamp and cut the cystic duct and cystic artery, then free the gallbladder, check for bleeding in the gallbladder bed, use an electrocautery hook to cauterize and stop the bleeding, and finally put the gallbladder into a specimen bag and take it out through the operating port.

[0013] S5: The peritoneum and white abdominal line are continuously sutured, and the umbilical incision is sutured and reshaped using the anchoring method.

[0014] Preferably, the liver traction device in step S2.2 above includes a fixed hinge rod, characterized in that: a movable hinge rod is hinged at one end of the fixed hinge rod, a clamping mechanism is provided at the other end of the fixed hinge rod, a traction rope is provided inside the fixed hinge rod, an installation groove is provided on the fixed hinge rod, an adjustment mechanism is provided inside the installation groove, a sliding rod is provided at the top of the adjustment mechanism, a movable rod is hinged at the end of the sliding rod, an installation component is hinged at the end of the movable rod away from the sliding rod, the installation component is fixedly connected to the movable hinge rod, two mounting plates are fixedly provided at the end of the movable hinge rod away from the clamping mechanism, a pulley is hinged between the two mounting plates, and a puncture head is threaded at the end of the fixed hinge rod.

[0015] Preferably, the adjusting mechanism includes a plurality of first wedge blocks, a long rod, a second wedge block, an adjusting spring, two return springs, a stop block, an adjusting gear, an adjusting rack, a limiting pawl, a torsion spring, a connecting rod, an L-shaped plate, and a rotating shaft. The two return springs are disposed within the mounting groove, the long rod is disposed on top of the two return springs, the plurality of first wedge blocks are fixedly disposed on top of the connecting rod, the second wedge blocks are fixedly disposed on the bottom of the sliding rod, the adjusting spring is disposed on the side wall of the second wedge block, the connecting rod is fixedly disposed at one end of the long rod, the rotating shaft is rotatably disposed at the end of the connecting rod, the limiting pawl is rotatably disposed on the rotating shaft, the torsion spring is disposed on the rotating shaft, the L-shaped plate is fixedly disposed on top of the connecting rod, the adjusting gear is disposed on the side wall of the mounting groove, the adjusting rack is slidably disposed at the end of the mounting groove, and the stop block is fixedly disposed on top of the adjusting rack.

[0016] Preferably, the clamping mechanism includes two arc-shaped grooves, two clamping racks, a pull rod, two connecting posts, a clamping gear, two clamping discs, and a through groove. The two arc-shaped grooves are disposed on the side wall of the fixed hinge rod. The clamping gear is rotatably disposed inside the fixed hinge rod. The two clamping racks are slidably disposed on both sides of the clamping gear. The two connecting posts are fixedly disposed on the top of the two clamping racks. The pull rod is fixedly disposed at the end of one of the clamping racks. The two clamping discs are fixedly disposed on the top of the two connecting posts. The through grooves are disposed on the two clamping discs.

[0017] Preferably, the pull rod slides within the arc-shaped groove, and both clamping racks mesh with the clamping gears.

[0018] Preferably, the inner wall of the through groove is provided with anti-slip texture.

[0019] Preferably, one end of the traction rope is fixedly connected to one of the mounting plates, and the other end of the traction rope passes through the through groove, wherein the diameter of the traction rope is larger than the diameter of the through groove.

[0020] Compared with the prior art, the beneficial effects of the present invention are:

[0021] (1) This invention uses a self-made single-port multi-channel trocar: no additional commercial single-port multi-channel trocar is needed, saving medical costs and making it easy to set up in county hospitals. It also uses the Cross Hand method to enter the surgical instruments, effectively avoiding problems such as instrument collision during the operation. When the gallbladder is dissected by the ultrasonic scalpel, it can cut and stop bleeding. Furthermore, it uses the umbilical flipping technique and the anchoring method to reconstruct the umbilicus, reducing scar-related complications and lowering the incidence of postoperative incisional hernia.

[0022] (2) The present invention, through the arrangement of a first wedge block, a long rod, a second wedge block, an adjusting spring, two reset springs, a contact block, an adjusting gear, an adjusting rack, a limiting claw, a torsion spring, a connecting rod, an L-shaped plate and a rotating shaft, achieves the goal of maintaining the same traction force on the liver at all times, avoiding the problem of insufficient traction force on the liver leading to unclear vision as the gallbladder is cut deeper, better exposing the surgical field of the gallbladder triangle, reducing surgical time and improving surgical safety;

[0023] (3) The present invention, through the setting of arc groove, two clamping racks, pull rod, two connecting columns, clamping gear, two clamping discs and through groove, realizes that after unlocking, the device can be reset by pulling the traction rope, which is convenient for removal, cleaning and disinfection and the next use. Attached Figure Description

[0024] Figure 1 This is a schematic diagram of the overall structure of the liver traction device of the present invention;

[0025] Figure 2 This is a schematic diagram of the internal structure of the puncture head of the liver traction device of the present invention;

[0026] Figure 3 This is a cross-sectional view of the internal adjustment mechanism of the liver traction device of the present invention.

[0027] Figure 4 for Figure 2 Enlarged view of point A in the middle;

[0028] Figure 5 This is a schematic diagram of the clamping mechanism of the present invention.

[0029] In the diagram: 1. Fixed hinge rod; 2. Traction rope; 3. Mounting groove; 4. Movable hinge rod; 5. Adjustment mechanism; 51. First wedge block; 52. Long rod; 53. Second wedge block; 55. Adjusting spring; 56. Return spring; 57. Abutment block; 58. Adjusting gear; 59. Adjusting rack; 510. Limiting claw; 511. Torsion spring; 512. Connecting rod; 513. L-shaped plate; 514. Rotating shaft; 6. Clamping mechanism; 61. Arc groove; 62. Clamping rack; 63. Pull rod; 64. Connecting column; 65. Clamping gear; 66. Clamping disc; 67. Through groove; 7. Mounting component; 8. Movable rod; 9. Mounting plate; 10. Pulley; 11. Sliding plate; 12. Piercing head. Detailed Implementation

[0030] The technical solutions of the embodiments of the present invention will be clearly and completely described below with reference to the accompanying drawings. Obviously, the described embodiments are only some embodiments of the present invention, and not all embodiments. Based on the embodiments of the present invention, all other embodiments obtained by those skilled in the art without creative effort are within the scope of protection of the present invention.

[0031] Please see Figure 1-5 The present invention provides an embodiment of a single-port laparoscopic cholecystectomy method, which includes the following steps:

[0032] S1: After the patient is under general anesthesia via endotracheal intubation, an umbilical operating port is created using the umbilical inversion technique, and a single-port multi-channel trocar is inserted.

[0033] S2: Using standard surgical instruments for multi-port laparoscopic cholecystectomy, such as a 30° straight laparoscope, curved hemostat, non-traumatic grasping forceps, ultrasonic scalpel, and electrocoagulation hook, the cross-hand method is used to enter the surgical instruments and assess the degree of gallbladder inflammation and surrounding adhesions.

[0034] S2.1: Use non-abrasive forceps to pull up the bottom of the gallbladder to expose the Calot's triangle. If the Calot's triangle is obscured by segment III or IVb of the liver during this step, the field of vision cannot be fully exposed.

[0035] S2.2: At this time, the liver traction device is used. The tip is bluntly inserted through segment III or IVb of the liver and then through the abdominal wall. After externally pulling the liver traction device, the gallbladder triangle can be fully exposed.

[0036] S3: After the gallbladder triangle is clearly visible, use the Cross Hand technique to enter the ultrasonic scalpel and dissect the gallbladder triangle to expose the CVS;

[0037] S4: Use vascular clamps to clamp and cut the cystic duct and cystic artery, then free the gallbladder, check for bleeding in the gallbladder bed, use an electrocautery hook to cauterize and stop the bleeding, and finally put the gallbladder into a specimen bag and take it out through the operating port.

[0038] S5: The peritoneum and white abdominal line are continuously sutured, and the umbilical incision is sutured and reshaped using the anchoring method.

[0039] Specifically, the liver traction device described in step S2.2 above includes a fixed hinge rod 1, a movable hinge rod 4 hinged at one end of the fixed hinge rod 1, a clamping mechanism 6 at the other end of the fixed hinge rod 1, a traction rope 2 inside the fixed hinge rod 1, an installation groove 3 inside the fixed hinge rod 1, an adjustment mechanism 5 inside the installation groove 3, a sliding rod at the top of the adjustment mechanism 5, a movable rod 8 hinged at the end of the sliding rod, an installation component 7 hinged at the end of the movable rod 8 away from the sliding rod, the installation component 7 being fixedly connected to the movable hinge rod 4, two installation plates 9 fixedly installed at the end of the movable hinge rod 4 away from the clamping mechanism 6, a pulley 10 hinged between the two installation plates 9, and a puncture head 12 threaded at the end of the fixed hinge rod 1. The liver traction device is inserted into the liver, and then the cone 12 is rotated. The puncture head 12 is unscrewed. Then, the adjustment mechanism 5 lifts the liver to the maximum extent according to the gallbladder cutting situation during the operation. Then, the clamping mechanism 6 is unlocked so that the surgical staff can clearly observe the wound and the next cutting position even when the gallbladder is removed deep.

[0040] Specifically, the adjustment mechanism 5 includes several first wedge blocks 51, a long rod 52, second wedge blocks 53, an adjusting spring 55, two return springs 56, a contact block 57, an adjusting gear 58, an adjusting rack 59, a limiting pawl 510, a torsion spring 511, a connecting rod 512, an L-shaped plate 513, and a rotating shaft 514. The two return springs 56 are disposed in the mounting groove 3, the long rod 52 is disposed on the top of the two return springs 56, the several first wedge blocks 51 are fixedly disposed on the top of the connecting rod 512, and the second wedge blocks 53 are fixedly disposed on the sliding rod. At the bottom, the adjusting spring 55 is disposed on the side wall of the second wedge block 53, the connecting rod 512 is fixedly disposed at one end of the long rod 52, the rotating shaft 514 is rotatably disposed at the end of the connecting rod 512, the limiting pawl 510 is rotatably disposed on the rotating shaft 514, the torsion spring 511 is disposed on the rotating shaft 514, the L-shaped plate 513 is fixedly disposed at the top of the connecting rod 512, the adjusting gear 58 is disposed on the side wall of the mounting groove 3, the adjusting rack 59 is slidably disposed at the end of the mounting groove 3, and the abutment block 57 is fixedly disposed at the top of the adjusting rack 59. The second wedge block 53 is moved by the elastic force of the adjusting spring 55. The movement of the contact block 57 synchronously drives the sliding plate 11 to move. The movement of the sliding plate 11 drives the movable rod 8 to move synchronously. Due to the hinged arrangement between the movable rod 8 and the mounting part 7, the movable hinge rod 4 rotates around the end hinged to the fixed hinge rod 1 while the movable rod 8 moves, thereby lifting and traction the liver. At the same time as the second wedge block 53 moves, it will abut against the first wedge block 51. The first wedge block 51 moves down, driving the long rod 52 to move down synchronously. The long rod 52 moves down, driving the connecting rod 512 to move down. The downward movement of 512 causes the limiting claw 510 and L-shaped plate 513 to move downward. The downward movement of the limiting claw 510 causes the adjusting gear 58 to rotate. The rotation of the adjusting gear 58 causes the abutment block 57 to move synchronously. The abutment block 57 moves and thus abuts the end of the adjusting spring 55 again. This ensures that the distance between the second wedge block 53 and the abutment block 57 is always the same, so that the abutment force of the adjusting spring 55 on the second wedge block 53 is the same. This ensures that the same traction force is always maintained on the liver, avoiding the problem of insufficient traction force on the liver and unclear vision as the gallbladder is cut deeper. It also provides sufficient cutting space when cutting the gallbladder.

[0041] Specifically, the clamping mechanism 6 includes two arc-shaped grooves 61, two clamping racks 62, a pull rod 63, two connecting posts 64, a clamping gear 65, two clamping discs 66, and a through groove 67. The two arc-shaped grooves 61 are disposed on the side wall of the fixed hinge rod 1. The clamping gear 65 is rotatably disposed inside the fixed hinge rod 1. The two clamping racks 62 are slidably disposed on both sides of the clamping gear 65. The two connecting posts 64 are fixedly disposed on the top of the two clamping racks 62. The pull rod 63 is fixedly disposed at the end of one of the clamping racks 62. The two clamping discs 66 are fixedly disposed on the top of the two connecting posts 64. The through groove 67 is disposed on the two clamping discs 66. The downward pull rod 63 drives the clamping rack 62 to move, which in turn drives the clamping gear 65 to rotate. The rotation of the clamping gear 65 drives another clamping rack 62 to move, and the movement of the two clamping racks 62 drives the two connecting columns 64 to move synchronously. The movement of the two connecting columns 64 drives the two clamping discs 66 to open, thereby releasing the through groove 67 from clamping the traction rope 2. Furthermore, since the pull rod 63 abuts against the end of the long rod 52, the downward pull rod 63 synchronously drives the long rod 52 to move downward, thereby releasing the first wedge block 51 from abutting the second wedge block 53. At this time, pulling the traction rope 2 drives the movable hinge rod 4 to reset, which in turn drives the movable rod 8 to reset. The reset of the movable rod 8 drives the abutting block 57, the adjusting spring 55, and the second wedge block 53 to reset, making it convenient for the next use.

[0042] Specifically, the pull rod 63 slides within the arc-shaped groove 61, and both clamping racks 62 mesh with the clamping gear 65.

[0043] Specifically, the inner wall of the through groove 67 is provided with anti-slip texture.

[0044] Specifically, one end of the traction rope 2 is fixedly connected to one of the mounting plates 9, and the other end of the traction rope 2 passes through the through groove 67. The diameter of the traction rope 2 is larger than the diameter of the through groove 67.

[0045] Working principle: First, the fixed hinge rod 1 is punctured through the liver. Then, the cone 12 is rotated to unscrew the puncture head 12. Next, the second wedge block 53 is moved by the elastic force of the adjusting spring 55. The movement of the contact block 57 synchronously drives the sliding plate 11 to move. The movement of the sliding plate 11 drives the movable rod 8 to move synchronously. Due to the hinged setting between the movable rod 8 and the mounting part 7, the movable hinge rod 4 rotates around the end hinged to the fixed hinge rod 1 while the movable rod 8 moves, thereby lifting and tractioning the liver. At the same time, the second wedge block 53 abuts against the first wedge block 51. The first wedge block 51 moves down, driving the long rod 52 to move down synchronously. The long rod 52 moves down, driving the connecting rod 512 to move down. The connecting rod 512 moves down, driving the limiting claw 510 and the L-shaped plate 513 to move down. The moving of the limiting claw 510 drives the adjusting gear 58 to rotate. The rotation of the adjusting gear 58 drives the contact block... 57 moves synchronously, and the abutment block 57 moves to re-abut the end of the adjusting spring 55. Then, the downward pull rod 63 drives the clamping rack 62 to move. The movement of the clamping rack 62 drives the clamping gear 65 to rotate. The rotation of the clamping gear 65 drives another clamping rack 62 to move. The movement of the two clamping racks 62 drives the two connecting columns 64 to move synchronously. The movement of the two connecting columns 64 drives the two clamping discs 66 to open, thereby releasing the through groove 67 from clamping the traction rope 2. And because the pull rod 63 abuts the end of the long rod 52, the downward pull rod 63 drives the long rod 52 to move down synchronously, thereby releasing the first wedge block 51 from abutting the second wedge block 53. At this time, pulling the traction rope 2 drives the movable hinge rod 4 to reset. The movable hinge rod 4 drives the movable rod 8 to reset. The reset of the movable rod 8 drives the abutment block 57, the adjusting spring 55 and the second wedge block 53 to reset, making it easy to remove and use next time.

[0046] Although the present invention has been described in detail with reference to the foregoing embodiments, those skilled in the art can still modify the technical solutions described in the foregoing embodiments or make equivalent substitutions for some of the technical features. Any modifications, equivalent substitutions, improvements, etc., made within the spirit and principles of the present invention should be included within the protection scope of the present invention.

Claims

1. A single-port laparoscopic cholecystectomy device, comprising a fixed hinge rod (1), characterized in that: The fixed hinge rod (1) is hinged at one end to a movable hinge rod (4), and the other end of the fixed hinge rod (1) is provided with a clamping mechanism (6). A traction rope (2) is provided inside the fixed hinge rod (1). The fixed hinge rod (1) is provided with a mounting groove (3), and an adjusting mechanism (5) is provided inside the mounting groove (3). A sliding rod is provided at the top of the adjusting mechanism (5), and a movable rod (8) is hinged at the end of the sliding rod. A mounting component (7) is hinged at the end of the movable rod (8) away from the sliding rod. The component (7) is fixedly connected to the movable hinge rod (4). Two mounting plates (9) are fixedly provided at one end of the movable hinge rod (4) away from the clamping mechanism (6). A pulley (10) is hinged between the two mounting plates (9). A piercing head (12) is threaded at the end of the fixed hinge rod (1). The adjusting mechanism (5) includes several first wedge blocks (51), a long rod (52), a second wedge block (53), an adjusting spring (55), two return springs (56), a contact block (57), an adjusting gear (58), and an adjusting mechanism. The system includes a rack (59), a limiting claw (510), a torsion spring (511), a connecting rod (512), an L-shaped plate (513), and a rotating shaft (514). Two reset springs (56) are installed in the mounting groove (3). A long rod (52) is positioned on top of the two reset springs (56). Several first wedge blocks (51) are fixedly mounted on top of the connecting rod (512). Second wedge blocks (53) are fixedly mounted on the bottom of the sliding rod. An adjusting spring (55) is positioned on the side wall of the second wedge block (53). The connecting rod (512)... The rotating shaft (514) is rotatably mounted on the end of the connecting rod (512), the limiting claw (510) is rotatably mounted on the rotating shaft (514), the torsion spring (511) is mounted on the rotating shaft (514), the L-shaped plate (513) is fixedly mounted on the top of the connecting rod (512), the adjusting gear (58) is mounted on the side wall of the mounting groove (3), the adjusting rack (59) is slidably mounted on the end of the mounting groove (3), and the abutment block (57) is fixedly mounted on the top of the adjusting rack (59).

2. The single-port laparoscopic cholecystectomy device according to claim 1, characterized in that: The clamping mechanism (6) includes two arc-shaped grooves (61), two clamping racks (62), a pull rod (63), two connecting columns (64), a clamping gear (65), two clamping discs (66), and a through groove (67). The two arc-shaped grooves (61) are disposed on the side wall of the fixed hinge rod (1). The clamping gear (65) is rotatably disposed inside the fixed hinge rod (1). The two clamping racks (62) are slidably disposed on both sides of the clamping gear (65). The two connecting columns (64) are fixedly disposed on the top of the two clamping racks (62). The pull rod (63) is fixedly disposed at the end of one of the clamping racks (62). The two clamping discs (66) are fixedly disposed on the top of the two connecting columns (64). The through groove (67) is disposed on the two clamping discs (66).

3. The single-port laparoscopic cholecystectomy device according to claim 2, characterized in that: The pull rod (63) slides within the arc groove (61), and both clamping racks (62) mesh with the clamping gear (65).

4. The single-port laparoscopic cholecystectomy device according to claim 2, characterized in that: The inner wall of the through groove (67) is provided with anti-slip texture.

5. The single-port laparoscopic cholecystectomy device according to claim 4, characterized in that: One end of the traction rope (2) is fixedly connected to one of the mounting plates (9), and the other end of the traction rope (2) passes through the through groove (67). The diameter of the traction rope (2) is larger than the diameter of the through groove (67).

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