Object of the study: gall stone disease Purpose of the study: increase of efficiency of surgical treatment of patients with gall stone disease by the substantiated choice of minimally invasive intervention with the use of laparoscopic technologies and operations from minilaparotomy approach. Methods of the investigation: general clinical, biochemical, instrumental, topographic-anatomic and statistical. Theoretical and practical results: obtained results of investigation allowed to substantiate high-quality new strategy of the surgical treatment of gall stone disease, at which the number of conversions is taken to the minimum and the results of treatment of this category of patients get better. By the certain parameters of availability of minilaparotomy wound the methods of choice of the optimum approach for cholecystectomy (CE) were improved taking into account the features of anatomy of hepatobiliary area. Risk criteria of complications of CE were defined, which are set depending on the form of the gallbladder inflammation and its spread, character of the operations on abdominal organs carried earlier, and concomitant pathology. Instruments for operations from minilaparotomy approach on abdominal organs were offered (declarative patent of Ukraine №23659), which in association with the developed technical maneuvers of intervention allowed to improve quality and comfort of operation, considerably to multiply its efficiency. Taking into account above mentioned data the algorithm of surgical tactic was substantiated, which allows to define the optimum method of minimally invasive treatment of patients with gall stone disease, and is basis of objectification of indications to different operative procedures. Novelty: for the first time on the basis of mathematical design and in the experiment the dependence of possibilities of operating technique on the geometrical parameters of operating space was studied. On the basis of obtained findings the certain criteria of availability of wound were defined, which respond to request, which are pulled out to minilaparotomy operations. For the first time the significance of features of topography and sceletotopy of organs of the biliary system from data of ultrasound investigation (different types, forms and positions of liver and GB) for the choice of method of minimally invasive treatment of patients with GSD were studied and defined. It is shown that depth of location of the GB neck and elements of the Callot triangle, the type of their projection anatomy and angle of the GB axis carries out substantial influence on complications of implementation of CE, number of intra- and postoperative complications and rate of conversions. On the basis of obtained findings about dependence of geometry of operating wound and position in space of organs of biliary area the adapted to these conditions instruments were developed, that allows to get the maximal parameters of availability and luminosity of minilaparotomy wound. At the use of different sources the light (light-emitting diode, operating lamp) luminosity of area of intervention was studied. On the basis of information about topographic and anatomic position of liver and GB, degree of spread of inflammatory changes in the area of intervention the individualized algorithm of choice of minimally method of CE is improved. Degree of introduction: the developed diagnostic and tactical charts of the minimally invasive treatment of GSD are applied in surgical practice of Institute of General and Urgent Surgery of AMS of Ukraine, Kharkiv City Hospital of Urgent Medical Aid named after prof. О.І.Meschaninov, Valky Central District Hospital of the Kharkiv region. Sphere of application: medicine, surgery.
