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Текст наукової роботи на тему «LAPAROSCOPY DEVELOPMENT TRENDS»
BECTM HAYmiX AOCTMEHMM.
LAPAROSCOPY DEVELOPMENT TRENDS
Lutsevich Oleg1, Rozumny Arkady2, Mikhailov Vladimir3
1 Lutsevich Oleg Emmanuilovich - head of Department, Professor, Doctor of Medical Sciences, Corresponding Member of the Russian Academy of Sciences, Professor, Honored Scientist of the Russian Federation, Honored Doctor of the Russian Federation Chairman of the Society of Surgeons of Moscow and the Moscow Region, member of the Board of the Society
of Endosurgery of Russia
2 Rozumny Arkady Petrovich - MSMSU, Associate Professor, Head of Department part of the cafe. faculty surgery 1 3 Mikhailov Vladimir Gennadievich - MGMSU, assistant department Fak. Surgery 1, Ph.D.
To cite this article: Lutsevich O.E., Rosumny A.P., Mikhail V.G. - LAPAROSCOPY DEVELOPMENT TRENDS // News of scientific achievements. Medicine and pharmacy - 2019. - № 1. - S. 10-13. DOI: 10.36616 / 2713-1718-2019-1-1013 URL: https://vestind.org.ua/journals/medicine/releases/2019-1/articles?pdfView&page = 10
Received: November 18, 2019; Accepted: November, 22, 2019; Published: December 28, 2019
Abstract: This article deals with the most modern trends in the development of laparoscopy. The author gives a brief description of this type of surgical intervention, and also outlines the problems that exist in laparoscopy for the present period of time. The author also analyzes the main trends in accordance with which modern laparoscopy develops.
Keywords: laparoscopy, surgical intervention, patient, current trends, development, abdominal cavity, trauma.
The relevance of the study of the declared topic is due to the fact that at the present time there is a rapid development of such field of surgery as laparoscopy. Laparoscopic surgery is a modern method of surgical surgery. Laparoscopic operations, like minimally invasive surgery, allow surgeons to perform operations through small incisions (less than one centimeter long) compared to large incisions in traditional "open" surgical operations. The advantage of laparoscopic operations for patients is: reduction of pain syndrome, reduction of patient stay in hospital, improvement of cosmetic result and faster recovery after surgery. Accordingly, it seems appropriate to give a brief description of current trends in laparoscopy development.
According to a number of practicing surgeons, there are a number of unresolved problems in the field of surgery, the main ones being that the display of the abdominal cavity on the monitor is two-dimensional (flat), which complicates the observation of the operational field; The use by the surgeon of sufficiently long instruments whose motion amplitude is sufficiently limited; Lack of direct palpation of tissues and organs; Uncomfortable position of the surgeon during laparoscopic surgery. In order to eliminate the above-mentioned shortcomings, research is
under way to create new technologies in the following areas:
- Obtaining a three-dimensional (volume) image on the monitor;
- Creation of gloves with special press sensors;
- Improvement of tools with increased volume of movements;
- Creation of a surgical console, which would combine the data on the state of abdominal organs at the moment with the data obtained during CT and MRI;
- Creation of robots [3, p. 39].
2. Methods and technologies
Further, it seems advisable to focus on those modern technologies that are already used in laparoscopic surgery.
For example, the only effective and radical method of treating bile disease is the operative removal of the gall bladder (cholecystectomy). The "gold standard" for the treatment of this disease among all surgical methods today is laparoscopic cholecystectomy. It is a mini-invasive, low-traumatic surgical intervention that allows to remove the gallblthe through 4 punctures with the help of a special optical laparoscope device.
Duration of operation is 30-50 minutes, and duration of stay in hospital after operation is on
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average up to 2 days.
Radical treatment of hernias is only surgical and can be carried out in an open traditional way or laparoscopically. The method of laparoscopic hernioplasty is low-traumatic (3 punctures on the anterior abdominal wall), allows to reduce the operation time to 30-40 minutes.
At operations for inguinal, femoral, umbilical, postoperative ventral hernias the intraabdominal plasticity with use of a grid of PROCEED (ETHICON is applied that minimizes percent of a recurrence, reduces duration of the surgery and consequently also anesthesia duration that allows to prevent risk of development of complications from an abdominal cavity, and also other bodies and systems in the postoperative period [5, page 63].
This type of surgery does not require the use of drug pain relief in the postoperative period. Small operational trauma allows to activate patients within the first hours after operation.
Duration of operation is about 30-40 minutes, and duration of stay in hospital after operation is 1 day.
Pathological (morphid) obesity causes the development of hypertension, diabetes mellitus, ischemic heart disease, deforming arthrosis of knee and hip joints (Body Mass Index (BMI) - 35 and higher). The problem of overweight is solved radically only by surgical means. One method is to apply a band to the stomach. The surgical technique of laparoscopic application of gastric bandage in order to treat pathological obesity is spreading very rapidly in Europe. Over the past 6 years, more than 30,000 gastric bandages have been implanted in Europe. And this trend is increasing.
There are three important arguments explaining the increase in surgery in obesity:
- First, there has been a dramatic increase in pathological obesity worldwide;
- Secondly, the concept of previous diet treatment gives alarming, unsatisfactory results in the long term;
- Third, with the emergence and development of minimally invasive surgery methods, an effective, non-harming and reversible operative procedure of laparoscopic banding on the stomach has become possible [6, p. 91].
Gastric banding uses a special system for adjustable gastric straining to reduce patient
weight by reducing food intake. This system is a "cuff" of soft and durable silicone, which, when installed, divides the stomach into two parts: a small one - the upper one, and a large one - the lower one. Given that saturation receptors are located at the top of the stomach, they receive a "sat down" signal as soon as a small part of it is filled. The system is installed laparoscopically, through 4 punctures, allowing to reduce injuries of intervention (stomach cavity does not open), to reduce risk of operation and possibility of development of postoperative complications, to minimize discomfort in patients, and is also regulated, without affecting blood supply and gastric innervation. As a result, the patient 's body weight decreased to 50-70 kg, but not below physiological weight.
Duration of operation is on average 50 minutes, and duration of stay in hospital after operation - one day.
The hernia of the esophageal orifice of the diaphragm, as well as reflux esophagitis in ineffective conservative therapy, are subject to surgical treatment. To date, the most common and recognized worldwide is surgery - fundoplication (by Nissen), which is to sew the mobilized stomach floor around the esophagus, which prevents the development of reflux.
Conservative therapy allows only short-term reduction of manifestations of the disease, but does not eliminate its cause. With the use of laparoscopic technologies, laparoscopic croorography, Nsen 's fundoplication allows eliminating the cause of hernia, preventing the development of its complications, reducing the length of stay in hospital to 1-2 days, reducing the intensity of pain syndrome after surgery, accelerating the rehabilitation period and complete recovery of the patient [1, p. 13].
Duration of operation is up to 3 hours, and duration of stay in hospital after operation - one day.
Achalasia cardia is a chronic disease of the neuromuscular esophageal apparatus, which is characterized by a disorder of the reflex opening of the lower esophageal sphincter at the entrance to the stomach during swallowing. This is accompanied by disruption of the peristaltic movements of the esophagus, making it difficult for food to pass into the stomach. Various methods are used to treat this
disease depending on the stage of achalasia: endoscopic balloon dilation (expansion) of the lower esophageal opening (cardia), surgery -esophagocardiomyotomy.
Only invasive techniques allow to restore fully a natural passage (passing) of food masses on a gullet in a stomach. Laparoscopic esophagocardiomyotomy allows to significantly improve the quality of life of patients, eliminate the cause of the disease, which leads to complete recovery of the patient.
Duration of operation is up to 3 hours, and duration of stay in hospital after operation - one day.
Achalasia cardia is a chronic disease of the neuromuscular esophageal apparatus, which is characterized by a disorder of the reflex opening of the lower esophageal sphincter at the entrance to the stomach during swallowing. This is accompanied by disruption of the peristaltic movements of the esophagus, making it difficult for food to pass into the stomach. Various methods are used to treat this disease depending on the stage of achalasia: endoscopic balloon dilation (expansion) of the lower esophageal opening (cardia), surgery -esophagocardiomyotomy.
Only invasive techniques allow to restore fully a natural passage (passing) of food masses on a gullet in a stomach. Laparoscopic esophagocar-diomyotomy allows to significantly improve the quality of life of patients, eliminate the cause of the disease, which leads to complete recovery of the patient.
The duration of the operation is up to 3 hours. This transaction applies to "one day" transactions.
The only method of treating acute appendicitis is surgical removal of the worm-like process (appendix) - appendectomy. Appendectomy by laparoscopic techniques allows to reduce duration of surgical intervention and time of patient stay in hospital in postoperative period, as well as to minimize injury of tissues (skin, subcutaneous fat, muscles) during operation, to prevent development of hernias in the area of postoperative scar in late stages after operation [2, p. 28].
In order to perform laparoscopic appendectomy, it is necessary to perform only 3 punctures on the anterior abdominal wall.
Duration of operation is 40-50 minutes, and
ВЕСТИ НАУКОВИХ ДОСЯГНЕНЬ.
duration of stay in hospital after operation is 1-4 days.
3. Observations and Results
It is also necessary to say a few words about plasma technologies in this field of surgery.
The use of plasma technologies in laparos-copy has made these operations even more effective and safe for patients. The technology of laparoscopy in general remains the same - the doctor also makes several holes in the anterior abdominal wall of the patient, diameter up to 10 mm. Through one of these punctures a minivideo camera is introduced into the abdominal cavity of the person, which reflects the picture on the computer screen, and in the other hole the doctor instead of a classic laparoscopic scalpel introduces a thin nozzle of the PlasmaJet apparatus and moves it to the location of pathological tissue - tumor, cyst, myoma, endometriosis focus, erosion, etc. [4, p. 99]. All his actions at this surgeon sees on the monitor. The apparatus then PlasmaJet heats the inert argon gas, transforming the molecules into ions. The resulting plasma is delivered by the doctor to the tissue areas to be destroyed and evaporated.
After completion of operation, tool kit is removed from abdominal cavity, after which punctures are sutured. In the next step, the patient is taken out of anesthesia if general anesthesia is used. After that, the patient undergoes a short rehabilitation and can return to the usual lifestyle.
Thus, summing up the study, it can be generally concluded that, due to improved treatment outcomes, reduced treatment costs and patient requirements, laparoscopic operations have become widely used in the treatment of various surgical diseases over the past two decades. The improvement of instruments, video technologies and laparoscopic equipment accelerated the development of laparoscopic surgery. In some hospitals, more than 50% of operations are performed laparoscopically, and it is expected that more than 70% of operations can be performed using laparoscopic access without further technical improvements.
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© O.E. Lutsevich, A.P. Rosumny, V.G. Mikhailov, 2019
surgical intervention /
current trends /
abdominal cavity /