Liver retractor

Abstract

FIELD: medical equipment.SUBSTANCE: invention relates to a liver retractor. The liver retractor contains an element made in the form of a ring-shaped medical elastic band with a diameter of 8-10 cm with a system of three titanium hooks, two of which are designed for fixation to the crura of the diaphragm and the round ligament of the liver, and the third for fixation to the peritoneum in the left hypochondrium. The titanium hooks are 2.0 cm long. The curvature of the titanium hooks is 0.8 cm. The titanium hooks are spaced 5 cm apart.EFFECT: this invention allows for secure liver fixation during laparoscopic surgery on the upper gastrointestinal tract without the need for additional ports, reducing the risk of bleeding and tissue injury, minimizing surgical trauma, and improving cosmetic results.1 cl, 4 dwg

Description

[0001] The invention relates to medicine, namely to abdominal surgery, to instruments used in laparoscopic operations on organs of the upper gastrointestinal tract.

[0002] Analogues

[0003] A manual abdominal retractor (manufactured by ENDOMEDIUM) is known from NIEH (A set of instruments for endoscopic surgery. According to TU 9437-001-47086606-01: Retractor (1026-19) 32.50.13.190-00007254).

[0004] Abdominal retractor, manual, Set of instruments for endoscopic surgery NIEH "ENDOMEDIUM" according to TU 9437-001-47086606-01: Retractor (1026-02) is known.

[0005] Also known is the Natanson retractor, which is often used in laparoscopic surgery (OOO Etalon, Set of Natanson retractors 170-801-500).

[0006] Criticism of analogs

[0007] All similar instruments are inserted and introduced into the abdominal cavity through an incision beneath the xiphoid process. For surgical retraction of the left lobe of the liver, however, due to the risk of liver tissue injury, an assistant must be involved.

[0008] The use of analogous instruments in patients with a high BMI after unsuccessful placement can cause liver injury and damage. The placement of conventional retractors on the anterior abdominal wall leaves a skin scar, which is no longer acceptable with modern surgical approaches.

[0009] Invention prototype

[0010] We used the Natanson retractor (OOO Etalon, Natanson Retractor Set 170-801-500) as our prototype. The retractor is a curved rod, the proximal portion of which consists of two straight sections located in the same plane and has a 90-degree bend. The proximal end of the retractor has a 10 mm diameter, 50 mm long, extended section for fixation. At the distal end, perpendicular to the proximal portion of the retractor, is a hook for liver traction.

[0011] Prototype Criticism

[0012] The Nathanson retractor is inserted into the epigastric region of the abdominal cavity with its blunt end after removing a 5 mm diameter port. This increases the risk of bleeding, hematoma formation, and the formation of false bile ducts. Inserting the Nathanson retractor requires an additional port, i.e., a 5 mm incision in the anterior abdominal wall. This leaves a scar on the anterior abdominal wall, which impairs the cosmetic result.

[0013] Purpose of the invention

[0014] The purpose of the invention is to create a retractor that ensures reliable fixation of the liver during laparoscopic operations on the upper gastrointestinal tract without the need for additional ports, reducing the risk of bleeding and tissue injury, reducing surgical trauma and improving the cosmetic result.

[0015] Essence of the invention

[0016] The proposed device is illustrated in Fig. 1, 2, 3, 4.

[0017] Fig. 1

[0018] pos. 1 - titanium hook

[0019] pos. 2 - titanium hook

[0020] pos. 3 - titanium hook

[0021] pos. 4 - ring rubber.

[0022] Fig. 2 shows the general appearance of the retractor. Figs. 3 and 4 show photos of the retractor in practice. The proposed device consists of an annular medical elastic band (Fig. 1, pos. 4) with three titanium hooks. The proposed device is an annular medical elastic band approximately 8-10 cm in diameter (Figs. 3, 4) and three titanium hooks 2.0 cm long. The bending length of the titanium hooks is 0.8 cm. The titanium hooks are spaced 5 cm apart.

[0023] Two titanium hooks are secured to the crus of the diaphragm and the aponeurosis in the area of ​​the ligamentum teres, creating stable triangulation. A third titanium hook is secured to the peritoneum in the left subcostal region. This design allows for secure retraction of the left lobe of the liver, providing wide access to the surgical site (Fig. 3, Fig. 4).

[0024] The retractor contains a working element designed as a circular medical elastic band with a system of titanium hooks. Two titanium hooks are used for fixation to the crura of the diaphragm and the round ligament of the liver, and the third hook is used for fixation to the peritoneum in the left hypochondrium. This design allows for retraction of the left lobe of the liver, creating access to the crura of the diaphragm, the fundus of the stomach, and the pyloric sphincter, without the need for additional ports. The use of the circular medical elastic band reduces the risk of tissue injury, bleeding, and hematoma formation. The device allows for secure fixation of the liver in the surgical field, facilitating surgical procedures and increasing the safety of laparoscopic procedures.

[0025] Example of specific application of the device

[0026] Example 1

[0027] Patient M., 35 years old, was admitted to the clinic for planned surgical treatment with a diagnosis of stage III morbid obesity.

[0028] History: suffers from excess weight for about 10 years, repeated attempts to lose weight did not help, was observed by specialists, did not note a significant weight loss, and therefore was hospitalized for planned surgical treatment, performing a longitudinal resection of the stomach.

[0029] The patient underwent a standard preoperative examination in a clinical setting, after which the operation was performed: Laparoscopic longitudinal resection of the stomach.

[0030] During laparoscopic surgery for morbid obesity, after trocar placement and laparoscope insertion, it became necessary to retract the left lobe of the liver to provide access to the diaphragm, fundus of the stomach, and pyloric sphincter. The proposed retractor was introduced into the abdominal cavity through a standard 10 mm diameter port. Two retractor hooks were secured to the crura of the diaphragm and the round ligament of the liver. The third hook was secured to the peritoneum in the left hypochondrium. After tensioning the elastic band, the liver was displaced superiorly and laterally, providing convenient and safe access to the surgical site. During the surgery, secure liver retention was observed, with no bleeding or tissue damage. After completion of the procedure, the retractor was removed without complications within 12 seconds.Thus, the use of the proposed device made it possible to reduce the trauma of the intervention, ensure optimal visualization and increase the safety of the surgical intervention, as well as improve the cosmetic result (only three ports were installed on the anterior abdominal wall, i.e., three incisions up to 5-12 mm).

[0031] The postoperative period was uneventful.

[0032] The patient was discharged in satisfactory condition on the third day after surgery, for outpatient follow-up care.

[0033] Example 2

[0034] Patient N., 42, was admitted to the clinic for elective surgery with a diagnosis of stage 3 esophageal hernia and reflux esophagitis. Her medical history includes a long-term history of frequent heartburn, belching, and chest pain when eating. Instrumental examinations revealed stage 3 esophageal hernia. She was followed by specialists and received conservative therapy, but did not report any improvement. Therefore, she was hospitalized for elective surgery, including a Toupet fundoplication and cruroraphy.

[0035] The patient underwent a standard preoperative examination in a clinical setting, after which the operation was performed: Laparoscopic Toupet fundoplication, cruroraphy.

[0036] During a laparoscopic procedure, after trocar placement and laparoscope insertion, it became necessary to retract the left lobe of the liver to provide access to the diaphragm, fundus of the stomach, and pyloric sphincter. The proposed retractor was inserted into the abdominal cavity through a standard 10 mm diameter port. Two retractor hooks were secured to the crura of the diaphragm and the round ligament of the liver. The third hook was secured to the peritoneum in the left hypochondrium. After tensioning the elastic band, the liver was displaced superiorly and laterally, providing convenient and safe access to the surgical site without the need for additional ports. During the surgery, the liver was securely held, and there was no bleeding or tissue damage. After completion of the procedure, the retractor was removed without complications within 10 seconds.Thus, the use of the proposed device made it possible to reduce the trauma of the intervention, ensure optimal visualization and increase the safety of the surgical intervention, and improve the cosmetic result (only three ports were installed on the anterior abdominal wall, i.e., three incisions up to 5-12 mm).

[0037] The postoperative period was uneventful.

[0038] The patient was discharged in satisfactory condition on the third day after surgery, for outpatient follow-up care.

[0039] Example 3

[0040] Patient R., 42 years old, was admitted to the clinic for planned surgical treatment with a diagnosis of stage III morbid obesity. Concomitant symptoms: type 2 diabetes mellitus.

[0041] History: She has been overweight for about 12 years. Repeated attempts to lose weight have not helped. She has been observed by specialists, but has not noted significant weight loss. She also has a concomitant pathology, type 2 diabetes mellitus. Therefore, she was hospitalized for planned surgical treatment, performing a longitudinal gastrectomy.

[0042] The patient underwent a standard preoperative examination in a clinical setting, after which she underwent laparoscopic Roux-en-Y gastric bypass. During laparoscopic surgery for morbid obesity, after trocar placement and laparoscope insertion, it became necessary to retract the left lobe of the liver to provide access to the diaphragm, fundus of the stomach, and pyloric sphincter. The proposed retractor was introduced into the abdominal cavity through a standard 10 mm diameter port. Two retractor hooks were secured to the crura of the diaphragm and the round ligament of the liver. The third hook was secured to the peritoneum in the left hypochondrium. After tensioning the elastic band, the liver was displaced superiorly and laterally, providing convenient and safe access to the surgical area without the need for additional ports. During the surgery, the liver was securely held, and there was no bleeding or tissue damage.After completion of the procedure, the retractor was removed without complications within 12 seconds. Thus, the use of the proposed device reduced the surgical trauma, ensured optimal visualization, increased surgical safety, and improved the cosmetic outcome (only three ports were placed on the anterior abdominal wall, meaning three incisions of 5-12 mm).

[0043] The postoperative period was uneventful.

[0044] The patient was discharged in satisfactory condition on the fourth day after surgery, for outpatient follow-up care.

[0045] Features of the invention that distinguish it from the prototype

[0046] The proposed device is a ring-shaped medical elastic band about 8-10 cm in diameter (Fig. 3, 4) and 3 titanium hooks 2.0 cm long. The bending length of the titanium hooks is 0.8 cm. The titanium hooks are located 5 cm apart from each other.

[0047] Prototype Features

[0048] The prototype device consists of a bent stainless steel rod. The proximal portion consists of two straight sections aligned in the same plane, each with a 90-degree bend. The proximal end has a 10 mm diameter, 50 mm long, extended section for fixation. The distal end of the retractor, positioned perpendicular to the proximal portion, has a hook.

[0049] Positive effect from the use of the invention

[0050] During laparoscopic surgeries, the left lobe of the liver does not always provide good visualization. Our retractor allows for comfortable access to the crura of the diaphragm and the pyloric sphincter. This device allows for secure fixation of the liver within the surgical field without the need for additional ports or incisions. The retractor's design reduces the risk of bleeding, tissue injury, and hematoma formation. The elasticity of the material ensures gentle yet stable retraction, making surgical procedures safer and more precise. Thus, the invention minimizes surgical trauma, improves cosmetic results, and increases the effectiveness of laparoscopic interventions on the upper gastrointestinal tract.

[0051] Information taken into account

[0052] 1. Abdominal retractor, manual (firm "ENDOMEDIUM") NIEH (Set of instruments for endoscopic surgery. According to TU 9437-001-47086606-01: Retractor (1026-19) 32.50.13.190-00007254).

[0053] 2. Abdominal retractor, manual, Set of instruments for endoscopic surgery NIEH "ENDOMEDIUM" according to TU 9437-001-47086606-01: Retractor (1026-02).

[0054] 3. Natanson retractor (OOO "Etalon" Set of Natanson retractors 170-801-500).

[0055] 4. Natanson retractor (OOO "Etalon" Set of retractors according to Natanson 170-801-500) - Prototype.

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