3. Object of the study: Complicated forms of cholelithiasis (CL). Purpose of the study: To optimize low-invasive techniques in surgical treatment of CL. Methods of the investigation: Clinical, biochemical, im-munological; indices of LP-AOP; histological and electron-microscopic study of liver bioptates; ultrasound study of the abdominal organs, fibrogastroduedenoscopy, endoscopic retrograde cholangiopancreatography, intraoperative cholangiography. Practical significance of the obtained results: The developed mathematical model of troachar points allows individualizing the choice of optimum points of troachar insertion depending on the anthropometric features and topography of the gallbladder. Indications and terms of conversion at LCE were determined, efficacy of relaparoscopy in diagnosis and treatment of post-operative complications was shown. Laparoscopic cryotreatment of the gallbladder bed, laparoscopic subtotal cholecystectomy, laparoscopic cryovagotomy, laparoscopic fenestration of the liver cyst which allow to expand indications to low-invasive surgery in treatment of CL were worked out and introduced into practice. Novelty: The efficacy, indications and contraindications, opti-mum terms of surgery with the use of low-invasive techniques in patients with CL were determined. Experimental study of the damaging effect of monopolar electrocoagulation and cryotreat-ment on histomorphological and ultrasound structure of the liver was done, possibility to use cryotreatment on the gallbladder bed with the purpose of hemo- and cholestasis, stimulation of electro-thermal lesion regeneration and efficacy of cryodestruction of the mucous membrane of the gallbladder posterior wall were proven. For the first time, complex study of homeostasis state (immuno-logical reactivity, LP and AOP, histomorphological liver struc-ture) in -patients with complicated forms of CL before and after surgical correction with the use of low-invasive techniques was done. The degree of homeostasis changes was shown to depend on thedisease duration, the character of CL complications, and the technique of surgery. LCE caused less prominent disturbances of homeostasis when compared with traditional cholecystectomy. Optimal laparoscopic approaches were suggested, they were used to work out a mathematical model of troachar points in LCE. An original laparolifting technique in patients with an increased op-erative risk was suggested. The indications to gas-free CLE were determined. The system of measures aimed at prevention of intra-operative and early post-operative LCE complications was worked out. The efficacy and safety of tissue dissection using ultrasound scalpel in complicated forms of CL were shown. Degree of introduction: The findings of the research were intro-duced into the work of surgery departments of Railway Hospital (Kharkiv), regional clinical hospitals (Ternopol and Sumy), Kharkiv Regional Hospital for Radiation Protection, Kharkiv Military Hospital, city hospitals (No. 2 and for urgent medical aid), Sumy (No. 1 and 5), Central District Hospital (Chuguev). The findings of the research are used in the teaching process at surgery department of Kharkiv National University named after V.N. Karasin. Sphere of application: Medicine, surgery.
