DIFFERENTIATED CHOICE OF THE MINIINVASIVE SURGICAL APPROACH IN SURGICAL TREATMENT OF CHOLELITHIASIS

In 2009 at the University Clinic of the Odessa National Medical University with minilaparoscopic and single-port technology we have operated 47 patients with cholelithiasis. 26 patients were performed minilaparoscopic cholecystectomy, 21 — laparoscopic cholecystectomy using a single laparoscopic access. All surgical interventions had no intraoperative complications. In 5 patients because of anatomic difficulties in removing the gallbladder, we were used to installing an additional trocar in the epigastric region. Time used for interventions ranged from 30 to 130 minutes. Patients were hospitalized after the surgery from 1 to 4 days. Technically, the performance of single-port laparoscopic cholecystectomy was more difficult than the traditional laparoscopic or minilaparoscopic operations due to lack of conditions for the quality triangulation, visualization of anatomical structures in the area of operation and the small angle between the operating instruments. Particular attention was devoted to adequate closure of the abdominal wall defect after installing the port. Pain after use minilaparoscopic surgery was significantly less than with traditional laparoscopic approach. The intensity of pain after single-port operations, was comparable with that of conventional traditional laparoscopy. At follow-up of patients during the first months after surgery separated complications were not observed, marked by a beautiful cosmetic effect. 8 months after surgery 1 patient was diagnosed trocar-site hernia after a single port laparoscopic cholecystectomy.