METHOD FOR CHOLECYSTECTOMY THROUGH SINGLE LAPAROSCOPIC APPROACH IN ACUTE CHOLECYSTITIS Russian patent published in 2015 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: umbilical approach is formed. A device for single laparoscopic approach is inserted. A carboxyperitoneum is created. A gallbladder bottom is fixed. An abdominal wall is pricked through in a right hypochondrium. A pointed needle is inserted into the abdominal cavity. A gallbladder wall is pricked under the control of a videolaparoscope. The gallbladder contents is aspirated through a hollow needle. A needle tip is brought out of the gallbladder. A type of inflammation of its wall is visually assessed to select a string of the correct diameter. A doubled metal string 0.1-0.3 mm in diameter is inserted into the needle. The metal string is projected as a loop into the abdominal cavity. The loop is placed within the lateral surface of the gallbladder neck wall. Endoscopic forceps are inserted through the device for single laparoscopic approach. The forceps are advanced into the projected loop opening. The forceps are used to grasp the gallbladder neck wall and pull it into the lumen opening. The loop is tightened. The string ends are fixed out of the abdominal cavity by grasping with the surgical forceps along an outer edge of the needle. The endoscopic forceps are removed from the gallbladder neck wall and moved towards the gallbladder bottom. The endoscopic forceps grasp the gallbladder bottom to cover a needle point. That is followed by traction of the gallbladder bottom with the endoscopic forceps towards a diaphragm. Traction of the gallbladder neck wall is caudal and lateral by manipulating the needle that makes visualise Calot's triangle. An electrosurgical hook inserted through the device for single laparoscopic approach to separate the duct and gallbladder artery, which are clipped and transected separately. The gallbladder is separated from a bed by means of the electrosurgical hook with alternating the medial and lateral direction of the neck traction. After the gallbladder is separated from the bed, the loop is removed from the gallbladder neck wall. The string is removed from the abdominal cavity. The bed is electrically coagulated. The gallbladder is removed through the device for single laparoscopic approach. The umbilical approach wound is closed in layers.

EFFECT: method provides performing all the stages of cholecystectomy through the single umbilical approach, ensuring a wide amplitude and freedom of manipulations by the new simplified method for grasping and holding the gallbladder as a loop within the neck and within the bottom by means of the endoscopic forceps, improving visualisation by eliminating the gallbladder contents outflow into the abdominal cavity, and makes it possible to fix the loop on the gallbladder neck wall.

2 cl, 3 dwg, 2 ex