MD124Y - Method of laparoscopic cholecystectomy - Google Patents
Method of laparoscopic cholecystectomy Download PDFInfo
- Publication number
- MD124Y MD124Y MDS20090048A MDS20090048A MD124Y MD 124 Y MD124 Y MD 124Y MD S20090048 A MDS20090048 A MD S20090048A MD S20090048 A MDS20090048 A MD S20090048A MD 124 Y MD124 Y MD 124Y
- Authority
- MD
- Moldova
- Prior art keywords
- gallbladder
- laparoscopic
- mucosa
- infundibulocystic
- removal
- Prior art date
Links
- 238000000034 method Methods 0.000 title claims abstract description 11
- 238000002192 cholecystectomy Methods 0.000 title claims abstract description 8
- 210000000232 gallbladder Anatomy 0.000 claims abstract description 16
- 210000004877 mucosa Anatomy 0.000 claims abstract description 8
- 206010052428 Wound Diseases 0.000 claims abstract description 4
- 208000027418 Wounds and injury Diseases 0.000 claims abstract description 4
- 210000000941 bile Anatomy 0.000 claims abstract description 4
- 230000015271 coagulation Effects 0.000 claims abstract description 3
- 238000005345 coagulation Methods 0.000 claims abstract description 3
- 238000002271 resection Methods 0.000 claims abstract description 3
- 210000001519 tissue Anatomy 0.000 claims abstract description 3
- 241001260012 Bursa Species 0.000 claims description 3
- 230000001483 mobilizing effect Effects 0.000 claims description 2
- 201000001352 cholecystitis Diseases 0.000 abstract description 5
- 238000002357 laparoscopic surgery Methods 0.000 abstract description 4
- 208000000197 Acute Cholecystitis Diseases 0.000 abstract description 2
- 206010008614 Cholecystitis acute Diseases 0.000 abstract description 2
- 206010008617 Cholecystitis chronic Diseases 0.000 abstract description 2
- 230000001154 acute effect Effects 0.000 abstract description 2
- 239000003814 drug Substances 0.000 abstract description 2
- 230000035876 healing Effects 0.000 abstract 1
- 241000229175 Calotes Species 0.000 description 4
- 210000001367 artery Anatomy 0.000 description 3
- 210000001096 cystic duct Anatomy 0.000 description 3
- 208000032984 Intraoperative Complications Diseases 0.000 description 2
- 208000035965 Postoperative Complications Diseases 0.000 description 2
- 206010057765 Procedural complication Diseases 0.000 description 2
- 210000001953 common bile duct Anatomy 0.000 description 2
- 238000002350 laparotomy Methods 0.000 description 2
- 238000011321 prophylaxis Methods 0.000 description 2
- 238000001356 surgical procedure Methods 0.000 description 2
- 230000007704 transition Effects 0.000 description 2
- 206010004637 Bile duct stone Diseases 0.000 description 1
- 201000009331 Choledocholithiasis Diseases 0.000 description 1
- 208000015924 Lithiasis Diseases 0.000 description 1
- 201000005267 Obstructive Jaundice Diseases 0.000 description 1
- 210000003815 abdominal wall Anatomy 0.000 description 1
- 210000000013 bile duct Anatomy 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
- 230000001684 chronic effect Effects 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 230000002349 favourable effect Effects 0.000 description 1
- 230000023597 hemostasis Effects 0.000 description 1
- 230000002757 inflammatory effect Effects 0.000 description 1
- 230000004054 inflammatory process Effects 0.000 description 1
- 230000003902 lesion Effects 0.000 description 1
- 230000002980 postoperative effect Effects 0.000 description 1
- 230000028327 secretion Effects 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
- 238000012800 visualization Methods 0.000 description 1
Landscapes
- Materials For Medical Uses (AREA)
Abstract
Inventia se refera la medicina, in special la chirurgia laparoscopica si poate fi utilizata pentru colecistectomia laparoscopica la pacientii cu colecistita acuta sau cronica cu risc major de lezare a coledocului. Metoda, conform inventiei, include efectuarea acceselor laparotomice, mobilizarea vezicii biliare, deschiderea lumenului ei pe peretele anterior, de la fund pana la col, aspiratia bilei, inlaturarea calculilor din vezica, efectuarea rezectiei peretilor partii libere ale vezicii biliare pana la nivelul patului ei, inlaturarea tesuturilor rezecate, coagularea mucoasei peretelui posterior restant al vezicii biliare si a mucoasei regiunii infundibulocistice, aplicarea unei suturi „in bursa” in regiunea infundibulocistica, sanarea, drenarea spatiului subhepatic si suturarea plagilor laparotomice.The invention relates to medicine, in particular to laparoscopic surgery and may be used for laparoscopic cholecystectomy in patients with acute or chronic cholecystitis with a major risk of cholecystectomy. The method, according to the invention, includes laparotomic accesses, mobilization of the gallbladder, opening of its lumen on the anterior wall, from bottom to neck, aspiration of the bile, removal of bladder calculations, performing resection of the free part of the gallbladder up to the level of her bed, removal of the resected tissues, coagulation of the mucosa of the remaining posterior wall of the gallbladder and mucosa of the infundibulocystic region, application of a "stock market" suture in the infundibulocystic region, healing, drainage of the subhepatic space and suturing of the laparotomic wounds.
Description
Invenţia se referă la medicină, în special la chirurgia laparoscopică şi poate fi utilizată pentru colecistectomia laparoscopică la pacienţii cu colecistită acută sau cronică cu risc major de lezare a coledocului. The invention relates to medicine, in particular to laparoscopic surgery and can be used for laparoscopic cholecystectomy in patients with acute or chronic cholecystitis with a major risk of damage to the common bile duct.
Este cunoscută metoda de colecistectomie laparoscopică care constă în următoarele: sub control laparoscopic cu ajutorul instrumentelor este expusă vezica biliară, se prepară şi se mobilizează ductul cistic şi artera cistică în zona triunghiului Calot, după care ambele elemente se clampează şi se secţionează. Vezica biliară se decalează de patul biliar cu efectuează hemostaza patului, se sanează şi se drenează spaţiul subhepatic, se înlătură vezica biliară. Orificiile plăgilor peretelui abdominal se suturează [1] . The laparoscopic cholecystectomy method is known, which consists of the following: under laparoscopic control with the help of instruments, the gallbladder is exposed, the cystic duct and the cystic artery are prepared and mobilized in the area of the Calot triangle, after which both elements are clamped and sectioned. The gallbladder is shifted from the biliary bed, hemostasis of the bed is performed, the subhepatic space is cleaned and drained, the gallbladder is removed. The openings of the abdominal wall wounds are sutured [1].
Dezavantajul constă în faptul că în cazul procesului inflamator sever în zona triunghiului Calot, prepararea şi mobilizarea ductului cistic şi arterei cistice este dificilă sau chiar imposibilă. În primul caz există pericolul lezării căii biliare principale (CBP) cu consecinţe grave pentru bolnavi, în al doilea caz, chirurgul este impus să efectueze laparotomia. The disadvantage is that in the case of severe inflammatory process in the area of Calot's triangle, preparation and mobilization of the cystic duct and cystic artery is difficult or even impossible. In the first case there is a risk of damage to the common bile duct (CBP) with serious consequences for the patient, in the second case, the surgeon is forced to perform laparotomy.
Problema pe care o rezolvă invenţia constă în preîntâmpinarea trecerii de la operaţia laparoscopică la cea tradiţională, precum şi profilaxia leziunilor CBP. The problem solved by the invention consists in preventing the transition from laparoscopic surgery to traditional surgery, as well as the prophylaxis of CBP lesions.
Metoda conform invenţiei include efectuarea acceselor laparoscopice, mobilizarea vezicii biliare, deschiderea lumenului ei pe peretele anterior, de la fund până la col, aspiraţia bilei, înlăturarea calculilor din vezică, efectuarea rezecţiei pereţilor părţii libere a vezicii biliare până la nivelul patului ei, înlăturarea ţesuturilor rezecate, coagularea mucoasei peretelui posterior restant al vezicii biliare şi a mucoasei regiunii infundibulocistice, aplicarea unei suturi „în bursă” în regiunea infundibulocistică, sanarea, drenarea spaţiului subhepatic şi suturarea plăgilor laparoscopice. The method according to the invention includes performing laparoscopic accesses, mobilizing the gallbladder, opening its lumen on the anterior wall, from the bottom to the neck, aspiration of bile, removal of stones from the bladder, resection of the walls of the free part of the gallbladder up to the level of its bed, removal of resected tissues, coagulation of the mucosa of the remaining posterior wall of the gallbladder and of the mucosa of the infundibulocystic region, application of a "bursa" suture in the infundibulocystic region, sanitation, drainage of the subhepatic space and suturing of laparoscopic wounds.
Rezultatul invenţiei constă în simplificarea intervenţiei chirurgicale, profilaxia complicaţiilor intra- şi postoperatorii. The result of the invention consists in simplifying the surgical intervention, prophylaxis of intra- and postoperative complications.
Metoda se realizează în felul următor: sub control laparoscopic după expunerea colecistului, cu un cârlig-electrod se efectuează o incizie a peretelui anterior al vezicii biliare de la fundul ei până la locul vizualizării zonei înfundibulocistice. Concomitent bila din colecist se aspiră, iar calculii sunt amplasaţi într-un săculeţ de cauciuc şi se înlătură. Pereţii veziculei biliare din partea medială şi laterală sunt rezecaţi până la nivelul patului biliar. Rămâne peretele posterior al vezicii fixat de patul biliar. Pentru excluderea secreţiei, mucoasa este coagulată minuţios inclusiv şi mucoasa craterului infundibulocistic. Pe ultimul se aplică o sutură în bursă. The method is performed as follows: under laparoscopic control after exposure of the gallbladder, an incision is made with a hook-electrode of the anterior wall of the gallbladder from its bottom to the place of visualization of the infundibulocytic area. At the same time, the bile from the gallbladder is aspirated, and the stones are placed in a rubber bag and removed. The walls of the gallbladder from the medial and lateral sides are resected up to the level of the biliary bed. The posterior wall of the bladder remains fixed to the biliary bed. To exclude secretion, the mucosa is thoroughly coagulated, including the mucosa of the infundibulocytic crater. A suture is applied to the latter in the bursa.
Avantajele metodei Advantages of the method
Metoda este simplă în aplicare şi nu cere aparataj suplimentar. Efectuarea metodei reduce numărul cazurilor de conversie, trecerea la laparotomie şi exclude lezarea căii biliare principale prin abandonarea manipulaţiilor chirurgicale în zona triunghiului Calot şi pediculului cistic. The method is simple to implement and does not require additional equipment. Performing the method reduces the number of cases of conversion, the transition to laparotomy and excludes damage to the main bile duct by abandoning surgical manipulations in the area of the Calot triangle and the cystic pedicle.
Exemplu Example
Pacientul C., 83 ani, cu diagnosticul de colecistită cronică litiazică, coledocolitiază, icter mecanic. Patient C., 83 years old, with the diagnosis of chronic lithiasis cholecystitis, choledocholithiasis, mechanical jaundice.
Ca prima etapă a tratamentului chirurgical s-a efectuat papilosfincterotomia endoscopică cu litextracţie. După 3 zile s-a efectuat a doua etapă: colecistectomia laparoscopică. În timpul operaţiei s-au depistat schimbări inflamatorii severe în zona triunghiului Calot, iar prepararea ductului şi arterei cistice a fost imposibilă. Colecistectomia laparoscopică s-a efectuat după metoda menţionată. Evoluţie postoperatorie favorabilă. As the first stage of surgical treatment, endoscopic papillosphincterotomy with lithoextraction was performed. After 3 days, the second stage was performed: laparoscopic cholecystectomy. During the operation, severe inflammatory changes were detected in the area of the Calot triangle, and preparation of the cystic duct and artery was impossible. Laparoscopic cholecystectomy was performed according to the mentioned method. Favorable postoperative evolution.
Metoda a fost efectuată la 5 pacienţi în vârstă de la 46 până la 83 ani. După efectuarea intervenţiei laparoscopice complicaţii intraoperatorii sau postoperatorii nu au fost înregistrate. The method was performed on 5 patients aged 46 to 83. After the laparoscopic intervention, no intraoperative or postoperative complications were recorded.
Duca S. Chirurgia laparoscopică. Cluj-Napoca, 2001, p. 138-149 Duca S. Laparoscopic Surgery. Cluj-Napoca, 2001, p. 138-149
Claims (1)
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20090048A MD124Z (en) | 2009-04-08 | 2009-04-08 | Method of laparoscopic cholecystectomy |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20090048A MD124Z (en) | 2009-04-08 | 2009-04-08 | Method of laparoscopic cholecystectomy |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| MD124Y true MD124Y (en) | 2010-01-29 |
| MD124Z MD124Z (en) | 2010-08-31 |
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Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| MDS20090048A MD124Z (en) | 2009-04-08 | 2009-04-08 | Method of laparoscopic cholecystectomy |
Country Status (1)
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| MD (1) | MD124Z (en) |
Families Citing this family (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD621Z (en) * | 2012-11-08 | 2013-11-30 | Георге АНГЕЛИЧ | Method for laparoscopic cholecystectomy in patients with hepatic cirrhosis |
Family Cites Families (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD2064G2 (en) * | 2002-06-05 | 2003-06-30 | Андрей ЛЕШКО | Endoscopic method of cholecystectomy |
| MD3093G2 (en) * | 2006-03-20 | 2007-02-28 | Георге АНГЕЛИЧ | Method of celioscopic cholecystectomy to patients with hepatic cirrhosis |
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| Publication number | Publication date |
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| MD124Z (en) | 2010-08-31 |
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