In dissertation, the results of clinical and laboratory study of 140 patients electively operated for chronic calculous cholecystitis are presented. Patients were randomized into control (n = 66) and main group (n = 74). In the control group, a standard four-port LCE was performed with clipper under endotracheal anesthesia and ALV. The working space was created by insufflation of the carboxyperitoneum at a pressure of 10-12 mm Hg. In the postoperative period, patients were administered with analgesics on request with various non-steroidal anti-inflammatory drugs. The patients in the main group underwent 3-port LCE, in 58, carboxyperitoneum with a pressure of 6-8 mm Hg was created, and in 16, a device for laparolifting was used. The transection of the cystic duct was carried out by the method of electrowelding, the prophylaxis of trocar hernias was applied. Analgesia in the perioperative period provided by the use of Dexalgin and Infulgan. General surgical parameters, parameters of hemodynamics, blood oxygen saturation and pH, as well as stress markers in the perioperative period were compared in groups. In addition, the pain syndrome and the required amount of analgesics were assessed, as well as the quality of life in the long-time period. The average duration of surgical intervention by modified method was significantly lower due to a shorter time for the installation of the ports and the absence of the need for clipping of the vesicle duct and artery (52.23±6.17 minutes in the main group and 65.15±5.37 minutes in the control group; p<0.05). The average length of hospital stay in the group where the standard laparoscopic cholecystectomy was performed comprised 7.52±0.36 days, in the main group - 3.26±0.27 days; p<0.05. No conversions or reoperation for complications were performed. The total rate of intraoperative complications in the main group was 4 (5.4 %), in the control group - 6 (9.09 %) cases. Comparison of the indicators for each complication between the groups did not show a statistically significant difference (p>0.05). The use of the standard-pressure carboxyperitoneum method (10-12 mm Hg) has a pronounced stress and traumatic effect on the patient's body, as evidenced by the increase in perioperative parameters of SBP and HR, mainly after the insufflation of CO2, the expressed variability of the reaction of the cardiovascular system for insufflation of carbon dioxide - a sharp increase or decrease in SBP, heart rate. In addition, in the control group, there were significantly higher, compared to preoperative, mean values of plasma cortisol, IL-6, and a significant decrease in the levels of SpO2 and pH was observed. When comparing the pain scores by VAS scale on day 1 after surgery, it was found that the mean values in the control group were significantly higher than in the main group (3.8±0.24 and 3.3±0.18 p<0.001). The total dose of NSAIDs that was administered for analgesia in the early postoperative period, frequency and duration of administration were significantly lower in the main group. In 35 (53.03 %) patients of the control group, there were signs of shoulder syndrome due to the stretching the diaphragm with carboxyperitoneum and irritation of the diaphragmatic nerve. In the main group, this complication was determined only in 10 patients (13.5 %) (p<0.001). After 1 year, the results of the control examination of patients revealed the development of trocar hernias in 6 (9.09 %) patients in the control group, among which in 5 (7.58 %), the hernia appeared in the infraumbilical area, and in 1 (1,52 %) - at the point where the subxyphoidal port had been installed. At the same time, in the main group, this phenomenon was observed only in 2 (2.7 %) patients, which was significantly lower than in the control group (p<0.001). The results of inquiry by SF-36 questionnaire regarding the long-term quality of life (after 6 months) after surgery showed differences in certain health aspects with higher values in the main group.Thus, the results of the study confirm the rationality of performing minimally invasive surgical interventions in patients with gallstone disease complicated by chronic calculous cholecystitis using the modified method described above, taking into account both safety and ergonomics.
