METHOD OF LAPAROSCOPIC LIGATION OF THE APPENDIX DURING APPENDECTOMY Russian patent published in 2023 - IPC A61B17/12 A61B17/94 

FIELD: medicine, endoscopic surgery.

SUBSTANCE: trocars are inserted into the abdominal cavity, carboxyperitoneum is created, the appendix is isolated and ligated. The running end of the ligature is passed into the abdominal cavity through the trocar and circled around the base of the appendix so that the running end of the ligature passes to the right of the base of the appendix and fits over the root end of the ligature. The running end is crossed with the root end of the ligature and applied over it. Thus, a circular loop is formed around the base of the process with a diameter of 4 cm. Then, the root end of the ligature is taken from the place of intersection, while cutting it at the entrance to the trocar, thus freeing the root end of the ligature, without releasing the place of the intersection, lay the root end of the ligature in such a way that it formed a diametrical line crossing the circle formed by the running end of the ligature through the center to divide it in half. Moreover, the base of the process is adjacent to the root end of the ligature and is distal to it, remaining in the far sector of the circle, then the root end of the ligature is passed through the entire circle until it intersects and overlays on the running end from the diametrically opposite side. The second loop of the knot is formed in the following way: a section of the running end of the ligature, laid in a circle, is captured in the middle of this proximal sector, at 6-00 o'clock position of the virtual dial, the center of which is the base of the appendix, and at 3-00 and 9-00 o'clock position there are sections crossing the running end of the ligature and the root end of the ligature; the section of the running end of the thread is rotated counterclockwise with a clamp, a loop is obtained, into which the clamp is pulled through and the tip of the appendix mobilized from the mesentery is pulled; then both loops of the knot are brought down to the base of the process so that they are parallel to each other, without crossing, and the running end and the root end of the ligature are directed in opposite directions and come out from under the knot, grabbing the ends of the ligature with clamps, slowly pulling in opposite directions tighten node, pinching the base of the appendix. The divergence of the knot loops on the opposite side from the knot should not exceed 3 mm. Using the same technique, a double knot is applied to the removed part of the appendix, after which it is crossed and evacuated.

EFFECT: method is simple, while the time of surgical intervention is accelerated, intracorporeal knot tying is possible, and the postoperative period is painless.

1 cl, 4 dwg, 1 ex