Introduction. Such surgical methods as videolaparoscopic, endoscopic and other minimally invasive interventions have recently become widespread. But there is lack of discussion on efficacy and safety of modern methods of tissue dissection and hemorrhage removal. When performing endoscopic surgery, electrocoagulation is the method of choice. In this regard, the evaluation of the effectiveness of modern methods of tissue dissection of the ovary, liver cholestasis for hemostasis in surgery with endovideotools is of great practical interest. Polycystic ovary syndrome (PCOS) is currently one of the most studied diseases in modern gynecology. Thanks to the development of the team of the E. O. Paton Electric Welding Institute initiated by Academician B. E. Paton it became possible to use high-frequency electric current to connect the soft tissues. A designed EC-high-frequency generator and a set of 300M1 specialized equipment allow welding of tissues on the basis of dosing modulated current which is automatically generated depending on the tissue impedance.
Materials and methods. The study included 162 patients who were treated from 2007 to 2010 in the medical center “Motor Sich” (Zaporozhye): with cholelithiasis — 45 (27.78%) patients, with PCOS and benign ovarian cysts — 117 (72.22%) patients; 26 (16.05%) patients underwent operative simultaneous operations on cholelithiasis, and polycystic ovary syndrome.
With cholelithiasis (45 (27.78%) patients) — the control group consisted of 12 (26.67%) patients who underwent videolaparoscopic cholecystectomy with monopolar and bipolar electrocoagulation. The study group — 33 (73.33%) were performed videolaparoscopic cholecystectomy using the automatic welding of biological soft tissues generator.
Results and discussion. In the study group, 33 patients (32.35%) with cholelithiasis, intraoperative hemostasis in the bed of the gall bladder was performed using the generator of automatic welding of biological soft tissues. There were no conversions in this group. The rest of patients had “dry” drains. The most interesting data obtained by the comparative effectiveness in patients in the study group with PCOS were 69 (67.65%) patients, which underwent laparotomic surgery with the generator of automatic welding of biological soft tissues — 43 (62.32%) patients and videolaparoscopic operations — 26 (37.68%) women and using the generator of automatic welding of biological soft tissues, as a rule, these were: wedge resection of the ovary — 2 (7.69%), demedulation — 3 (11.54%) and the most part — enucleation cysts followed if necessary by treatment of bed with the generator of automatic welding of biological soft tissues — 21 (80.77%) patients. The use of automatic welding generator allowed to perform soft tissue homeostasis in conjunction with a modified wedge resection of the ovarian tissue. In all these cases, surgical intervention in the field of ovarian tissue was treated with the generator of automatic welding of soft tissues.
Conclusion. (1) Methodology for surgery with the help of the generator of automatic welding of biological soft tissue is the advanced surgical technology, based on the principle of one instrument in the “welding” and “cutting”, the main stages of surgical intervention in this case do not differ from traditional ones. (2) Analyzing advantages and disadvantages of the generator of automatic welding of biological soft tissue and monopolar, bipolar electrocautery, one should emphasize the significant differences of videolaparoscopic pictures of gallbladder bed and ovarian cyst’s bed, the remained ovary with the wedge resection after hemostasis. If after the electrosurgical treatment of ovarian cyst bed, or left ovary with its wedge resection, there was a solid area of coagulation necrosis, the result of the generator of automatic welding of biological soft tissues it was visually absent or there was a minimal zone of thermal damage to the liver and the remaining ovarian tissue. (3) Using of the generator of automatic welding of biological tissue can shorten the duration of surgery, making it technically easier and more convenient for the surgeon, and reduces the amount of intraoperative complications as well. (4) For morphological study of removed specimens there was revealed that alterative changes in the tissue of the gall bladder, or ovarian tissue exposed to electrothermal effects correspond to the area of application of tool electrodes and do not spread to surrounding structures, leaving them intact. In the area of intervention together with homogenized tissue there are tissue components including cells that are not structurally damaged, which is an evidence of further reparation and there is no loss of ovarian reserve in women with polycystic ovary syndrome and benign ovarian cysts on the background of PCOS.