Heinz

Kalk

Raul

Palmer

Kurt

Semm

Мурре

Harold

Hopkins

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.