Fatigue is a temporary decrease in the efficiency of an organism or organ due to intensive or long-term work, which is manifested in a decrease in quantitative and qualitative indicators of work and deterioration of coordination of work functions. Groups of simultaneous operations (411 patients) and group of single operations (746 patients) were formed. In both groups these changes were insignificant in most cases (except for marginal values in obese patients III, there were 6 such cases in the first group and 8 in the second), corrections of the port administration scheme were performed when performing vertical gastrectomy in both groups. After the calculation, the average deviations were 1.2 cm in the first group and 1.4 cm in the second. When using a laparoscope with a viewing angle of 0 o, the approach distance of the laparoscope with its own method of access on average during normal surgery is (6.92 ± 0.306) cm and is slightly smaller than standard methods, the average value of the studied parameter in the control group is-(6.98 ± 0.258) cm (p <0.001). Visualisation during simultaneous laparoscopic operations using our developed technique was on the level with single laparoscopic operation, performed classically.
Annotation. Aim of work – to define and evaluate visualization and ergonomics during single laparoscopic operations and simultaneous laparoscopic operations for gallstone disease and inguinal hernia. Identify the advantages and disadvantages of techniques. Assess whether our method affects ergonomics during surgery. The design of the study formed as retrospective comparative study with the control and research groups was used for evaluation and analysis. To form groups, a statistical database was used, which included 411 patients treated in VRSH MISD. Ergonomic parameters were analyzed and compared, such as the distance between the surgeon's hands, deviations depending on the patient's physique, the angle between the manipulators, the distance of approach to the target. Null hypothesis technique used, Pearson analysis, Tukey, Mann-Whitney. It is established that the angle between the main working tools 68.64±4.68o [64–73o] against 57.29±6.764o [44–65o] (p <0.001); the visualization area was 12.17±4.43 cm2 against 9.54±2.27 cm2 (p<0.001*); in the first and second groups, respectively; the average distance of the laparoscope approaching the operating area is greater when using a laparoscope with a 30o – viewing angle which is 3.84±0.37 cm [3.4–4.2] and 3.34±0.728 cm [2.5–4.5] for our own and French methods 3.21±0.24 cm [3.0–3.5] vs. 3.41±0.478 cm [2.7–4.1] at an angle of 0o). Performing a simultaneous laparoscopic intervention does not have any significant effect on the imaging and ergonomics during surgery. The technique allows to perform surgical treatment of inguinal hernia and cholecystolithiasis at one time without worsening of ergonomics. The technique found out in VRSH MISD is sufficiently effective and usable.
Annotation. Aim of work – to evaluate the quality of medical aid for the regular and simultaneous treatment of patients with gallstone disease in combination with a hiatal hernia. To evaluate the safety of simultaneous operations in the treatment of such patients. Determine advantages and disadvantages of both treatment strategies. Assess the ergonomics of laparoscopic surgery techniques. For sampling the database, statistic collected at the laparoscopic surgery unit of the Volynian Regional Clinical Hospital was used. The number of patients was 332. Patients were formed into two groups: the group of simultaneous laparoscopic treatment (laparoscopic cruroraphy with Toupet fundoplication and laparoscopic cholecystectomy with advanced surgery technique) – the first group of 126 people, and the group with only one operation (laparoscopic cruroraphy) was performed – the second group of 206 patients. The method that was chosen in first group (simultaneous laparoscopic treatment with advanced technique) allowed to prevent re-hospitalization, one more operation, and all associated risks (surgical, anesthesiologycal). Though the cost was a slight increased time of surgery (52 minutes versus 41), as well as a slightly increased the average hospital stay (3.25 days versus 3.1 days) comparing to a single surgery group. Complication rate didn`t increased significantly (5.5% in the first group versus 6.3% in the second group), with zero mortality in both groups. These data allow us to notice the safety and value of this treatment method and to continue its research and testing. The method can be linked to increasing the efficiency of medical care by reducing the number of hospitalizations, the total hospital stay, and reducing the overall cost of treatment, minimizing the cost of dealing with the complications.
Annotation. Aim of work - to investigate the impact of the developed technique of simultaneous laparoscopic operations on the results of treatment of surgical hepatobiliary pathology, to analyze and compare the main indicators of efficiency and safety of own technique with the "French" technique of cholecystectomy. During period from 2013 to 2019, 253 patients with combined hepatobiliary pathology and gallstone disease were treated using our own simultaneous surgery technique (group 1) and 328 patients with only gallstone disease treated using standard 'French technique' (group 2). The comparison was made through the analysis and comparison of such indicators as the duration of treatment, duration of surgery, serum creatinine concentration, glycemia, blood pressure. Shapiro-Wilk statistical methods, Mann-Whitney criteria or U-test were used. The following results were obtained: the duration of the operation was 66.14±6.21 minutes in the first group against 42.6±4.72 minutes in the second and did not exceed 2 hours; blood creatinine concentration did not exceed the allowable 2 mg/dl in both groups and differed slightly (p = 0.937), normalized in the period 6-12 h; glycemia also did not differ between the study and control groups and normalized during the recovery period of oral nutrition (p=0.822); Blood pressure was monitored to maintain normotony, the difference between intraoperative parameters in both groups was insignificant (p=0.912); the length of stay had no statistically significant difference between the groups (p=0.784) and was 3.53 days for the first and 3.45 for the second group. The method is valid for modern requirements, and the technique justifies its use.
Length of stay is one of the most evident indexes in evaluation of efficiency and expediency of treatment methods. It is useful to exploit it to compare different approach of treatment of the same pathology. Aim of our work was to analyze effectiveness of simultaneous operations for treatment surgical pathology of organs of abdominal cavity and gallstone disease. To compare the results of simultaneous treatment with results of classical treatment. We used statistics formed of 1157 patients that underwent operations in minimal invasive surgery unit of Volynian regional clinical hospital (Lutsk,Ukraine) in period of 2013-2019 years. Patients were divided into two groups. The research group (Group 1) was formed by 411 patient that underwent simultaneous laparoscopic surgery for treatment of gallstone disease and combined surgical pathology of organs of abdominal cavity. The control group (Group 2) was formed by 746 patients that underwent mono laparoscopic operation for treatment only one pathology of abdominal cavity. Groups were compared using such indexes as length of stay, number of conversions, number of complications, time of the operation. In the result terms of hospital stay were 3.52 days in group 1 and 3.55 days in group 2. Conversion was performed in 0.48% of patients in group 1 vs. 0.4% in group 2. Number of intraoperative complications was 1.93% in research group vs 2.14% in control. Time of operation was longer in group 1 vs group 2 up to 20% due to bigger volume of operation. The difference was smaller than operation itself. There were no operations that continued longer than 2 hours. Simultaneous operations are more effective because of its` suitability for combined pathology with no need for repeat hospitalization and operation. Simultaneous operations are as safe as standard mono operation.
Мета дослідження – порівняти розроблену техніку симультанних операційних втручань із звичайною технікою лапароскопічної холецистектомії за такими показниками, як безпека, час операції, час стаціонарного лікування, рівень ускладнень, втома хірургів після операцій. Матеріали та методи. У період із 2015 до 2019 р. у ВІМДЛ ВОКЛ 284 пацієнтам були виконані операції. Хворих було поділено на дві групи: перша – 72 пацієнтки із поєднаною гінекологічною патологією (ГП) та жовчнокам’яною хворобою (ЖКХ) та друга – 212 пацієнток лише із жовчнокам’яною хворобою. Статистику опрацьовано у програмі «Statistica v12.6». Використано аналіз критерію Шапіро–Уїлка, статистичні методи порівняння Манна–Уїтні, або U-критерій та ANOVA. Критичний рівень значущості р у всіх розрахунках визначено як 0,05. Результати дослідження та їх обговорення. Час операції склав (53±4,18) хв (31–66 хв) для першої групи і (41±3,77) хв (27–60 хв) – для другої. Зростання на 12 хв, або 23,6 %. Термін стаціонарного лікування склав 3,29 (2–8) дня у першій групі проти 3,32 (2–8) дня у другій (p=0,941). Рівень ускладнень в обох групах був зіставним і не відрізнявся значуще (p=0,966). Зміна критичної частоти злиття мерехтінь (КЧЗМ) у першій групі становила 2,25 Гц, а у другій – 2,18 Гц (p=0,928). Відносна сила знизилась у досліджуваній групі на 5,96 %, а в контрольній – на 5,73 % (p=0,970). Різниця у показниках між групами була незначущою, крім часу операції. Зростання було незначним, що не може конкурувати із показниками окремої операції. Висновки. 1. Виконання симультанних лапароскопічних втручань розробленою технікою для лікування жовчнокамʼяної хвороби та поєднаної хірургічної гінекологічної патології не приводить до збільшення тривалості лікування у стаціонарі, збільшення кількості ускладнень, фізичної чи психологічної втоми хірургів. 2. Збільшення тривалості операції не було критичним і не може конкурувати в часі з однією окремою операцією для цієї патології. 3. Симультанні лапароскопічні операції є оптимальними для хворих із поєднаною ЖКХ та ГП, а техніка, розроблена на базі ВІМДЛ ВОКЛ, є оптимальним вибором для виконання таких операцій.
Summary. Aim of work: to determine and compare the level of visualization, comfort, safety and effectiveness of simultaneous technique of laparoscopic surgery of gallstone disease and concomitant hiatal hernia and standard «baseball diamond» technique of laparoscopic surgery of only hiatal hernia. Materials and methods: the study was performed based on data developed in MISU VRCH. 359 patients were treated and divided on two groups, of which the group №1 — patients who underwent simultaneous laparoscopic cholecystectomy and cruroraphy with Toupet fundoplication (n=155), and group №2 — patients who underwent only laparoscopic crurography with with Toupet fundoplication. The level of visualization, comfort, frequency of «fencing», duration of operation, length of hospital stay, complication frequency were determined. The method with the null hypothesis, Pearson’s analysis, Mann-Whitney method were used. The results of the study: the approach distance of the laparoscope was (8,11 ± 0,917) and (8,71 ± 0,256) cm for 30°-optics while (6,55 ± 0,491) and (6,66 ± 0,485) cm for 0°-optics in two groups, respectively. The frequency of fencing was just about 4 episodes in both groups and did not differ statistically significantly. The frequency of the need to change the viewing area` and the frequency of the need to change the position of the instruments did not differ statistically significantly in both groups. The operation time was longer in the group of simultaneous operations by 10 % or 4,24 minutes. The level of complications was comparable in both groups, no correlation was found. The length of hospital stay was (3,64 ± 0,71) days (2-8 days) versus (3,58 ± 0,67) days (2-8 days) for both groups, respectively (p = 0.967).
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