Курт Земм

Экспериментальная лапароскопическая

холецистэктомия на животном, 1985

Филипп Мурэ (Phillipe Mouret) 1987

Advantages of endosurgery in comparison with traditional operations

Slight trauma of tissues

Short hospital period

Decrease of disability terms

Cosmetic effect

Decrease of frequency and weight of complications

Economic efficiency

Complications

General lethality come to 0,5 %, and frequency of complications – 10 %;

Wound infection – meets in 1-2 % of cases;

Damage of internal organs;

Pneumomediastinum, subcutaneous emphysema;

Pneumothorax;

Development of a gas embolism

Electrosurgical damages;

Cardiovascular collapse;

Postoperative pain in a right shoulder;

Damage of vessels and nerves of a forward belly wall;

Hernias of an abdominal wall.

Relative contraindications

Heavy accompanying pathology of cardiovascular and respiratory systems

-Obstructive diseases of lungs

-Cardiovascular insufficiency of 2-3 degrees

-Old myocardial infarction

-The transferred operations on heart and large vessels

-The congenital and acquired heart diseases

Diffuse peritonitis

Heavy coagulopathy

Adiposity of 3-4 degrees

Late terms of pregnancy

Portal hypertensia

Insufficient qualification of the operator

The minimal set for carrying out endoscopic operations

a)Needles for imposing pneumoperitoneum;

b)trocars with clamps and adapters;

c)Tools for suture of trocar apertures;

d)Manipulators: dissectors, cissors, clips, retractors;

e)The equipment for irrigation and aspiration;

f)Tools for coagulation;

i)Suture materials and tools for endoscopic suture;

j) Devices for ligation vessels and ducts.

The general requirements to endoscopic tools

а) Handiness: the handle of the tool should not complicate manipulations, at long operation there should not be a weariness of a wirst;

б) Sensitivity: the tool should provide the maximal sensitivity as the surgeon is deprived at endoscopic manipulations of tactile sensitivity;

в) Electroisolation: isolating layer should reach up to branches of the tool and to be strong enough;

г) Presence of the rotary mechanism providing rotation of a working part of the tool on 360 degrees around of a longitudinal axis.

Essentially the complex will consist of the following blocks:

a)A videocamera;

b)A video monitor;

c)The illuminator - the electronic device having a powerful lamp (xenon or halogen);

d)Laparoscope with an optical path;

e)Insufflator - it is intended for submission of carbonic gas in a abdominal cavity at imposing and maintenance of pneumoperitoneum;

f)Aquapurator - it is intended for washing and evacuation of liquid contents of a abdominal cavity;

i) Electrocoagulator; j) The rack - handcart.