[The place of the first trocar setting in laparoscopic cholecystectomy].
At the department of endovideosurgery the comparative evaluation of paraumbilical trocar intervention technique at the laparoscopic cholecystectomy was conducted at two groups of patients with calculous cholecystitis. There were 600 patients under supervision. It is discovered that the essential drawback of trocar intervention higher or lower than umbilical ring along the middle line is that while taking the gallbladder out the abdominal cavity, additionally the aponeurosis of the abdomen white line is dissected and later it has to be sutured. After such interventions during early postoperative period sensation of pain in the umbilical point appears, infiltrates are formed; ligature fistulas, seromas, hypodermic hematomas and later postoperative hernia may appear. A new technique of trocar intervention is proposed (patent of RF for invention # 2267300 of November 19, 2004). By topographic and anatomic, ultrasonic examination of anterior abdominal wall it was discovered, that the most acceptable area for trocar intervention at laparoscopic cholecystectomy is the medial border of the right musculus rectus abdominis in the umbilical area. The right-side transrectal access in the umbilical area at laparoscopic cholecystectomy allows to avoid postoperative complications connected with traditional trocar intervention through the white abdomen line in the form of pain syndrome and its continuity, presence of hematomas and accumulation of tissue fluid (seromas) in the wound.
Orekhov
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GI
D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation*; D002764:Cholecystitis / Q000209:etiology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus