METHOD OF ENDOSCOPIC VIDEO CHOLECYSTECTOMY Russian patent published in 2008 - IPC A61B17/94 

FIELD: medicine; surgery.

SUBSTANCE: Rohrer index is measured by the formula in patients with indications for endoscopic video cholecystectomy with accompanying diseases such as coronary heart disease, circulatory deficiency 1-11, moderate changes of the respiratory function, respiratory deficiency 1-11. The first session of hyperbarooxygenotherapy is held on the day before surgery, the second and the third sessions - on the first and the second days after surgery. Hyperbarooxygenothery sessions are held at excessive pressure of 0.5 - 0.7 atm, speed of pressure increase not more than 0.05 - 0.1 atm/minute, isopressure duration - 40 minutes. If Rohrer Index is 20 to 40 units, cholecystectomy is performed by inserting four trocars in the abdominal cavity. The subxiphoid 10-mm trocar is inserted between the upper and mid thirds of the distance between the xiphosternum and the navel to the right of the centre line. One of the 5-mm trocars is inserted along the right front axilla line 4 cm below the rib arch. The second 5-mm trocar is inserted between the right flank and the subxiphoid trocars or along the right midclavicular line 4 cm below the rib arch. If Rohrer Index is 41 to 60 units, endoscopic video cholecystectomy is performed at carboxyperitoneum pressure of 10 mm of mercury. In that case, the third instrumental trocar is inserted along the outer edge of the rectus at equal distance from the other trocars. Clips applied near the third instrumental trocar are tractioned vertically. In patients with Rohrer Index over 60 units, a fifth instrumental trocar for a trivalve retractor is inserted 5 cm below the right flank trocar. The use of this method allows to avoid the reverse Trendelenburg position 20°, limit the abdominal pressure to 10 mm of mercury, and conduct surgery with more favorable indicators of system hemodynamics.

EFFECT: faster restoration of blood gas composition in the post-surgery period, starting from the first day after surgery.

3 dwg, 4 tbl, 2 ex