Haley M. Substantiation of the safety and ergonomics of performing simultaneous laparoscopic surgical interventions in patients with combined surgical diseases of the abdominal cavity and extra-cervical space

The dissertation presents a theoretical justification and a new direction of solution of the current scientific problem of surgery, which is to develop a set of measures aimed at improving safety and ergonomics of simultaneous laparoscopic surgery on the abdominal cavity and retroperitoneal space based on the principles of fast track surgery. The level of fatigue during simultaneous laparoscopic surgical interventions on the abdominal cavity and retroperitoneal space of the members of the surgical team was studied based on the analysis of muscle strength of the hands and the frequency of flicker depending on the duration of surgery. It is proven that the degree of response to stress simultaneous laparoscopic operations according to their own methods and monooperations do not differ significantly and were characterized by low stress. Scientifically stated that, despite the increase in the volume and duration of simultaneous surgery, the degree of stress on the level of sympathicotonia and the degree of centralization of heart rate regulation was almost the same as in laparoscopic monooperations and was characterized by a sharp increase in 2-3 hours, recovery to preoperative indicators at the end of the second – beginning of the third day. Developed own methods of simultaneous laparoscopic operations, which differ from existing methods of performing monooperations on the following parameters: ergonomics, visualization of the target organ depending on the constitutional type of patient, safety. Based on the analysis of existing methods, the primary localization of laparoscopic ports and intraoperative change of port location at different stages of simultaneous surgical interventions in accordance with the location of the target organ was modified. Improved techniques for performing laparoscopic choledocholithotomy and cholecystectomy, fundoplication.