EAES Academy

Introduction:

In civil surgery the technique of dynamic laparoscopy is used. After operations that require re-examination "second look", in the anterior abdominal wall remains laparoport, through which further re-examination of the abdominal cavity. It allows to control the effectiveness of the previous operation. For all known methods of dynamic laparoscopy, conventional standard 10 mm laparoports are used. However, this technique is more suitable for inpatient conditions, for patients who do not require evacuation. The use of standard ports for the wounded, is impractical due to the possibility of complications during the evacuation, namely - damage to the abdominal organs by the trocar, pain during trocar movements. The use of dynamic laparoscopy in combat injuries of the abdomen at the stages of medical evacuation is not described in literature. When using a trocar, a number of significant disadvantages were identified: -the length of the trocar; - it is an inflexible rigid tube, which in case of uncontrolled movement can injure the organs; - causes pain when shifting body position; - limited ability to conduct re-examinations only with a laparoscope with a diameter of 10 mm; - Insufficient fixation in the anterior abdominal wall.
Aim: to improve the results of treatment of patients with combat trauma of the abdomen by using dynamic laparoscopy.
Materials and methods: For dynamic laparoscopy in the wounded we used standard plastic laparoports in two cases of fragmentary liver injury and in case of gunshot fragmentation injury of the ascending colon. With firearms taken into consideration the above shortcomings, we have developed a method of dynamic laparoscopy for combat injuries of the abdomen at the stages of medical evacuation with a reliable, convenient, safe, universal laparoport of soft material. The port for dynamic laparoscopy is used as follows. At the end of laparoscopy or laparotomy for abdominal injuries, a silicone port remains in the puncture site in a convenient place for inspection, which is fixed in the anterior abdominal wall due to areas of expansion in the upper and lower parts. After the condition stabilizes, the wounded person is sent to the next levels of medical care, where, according to the indications, dynamic laparoscopy is performed. It is possible to use both a 10 mm and a 5 mm cameras.
Results and conclusion: the effectiveness of the "method of dynamic laparoscopy for combat injuries of the abdomen" was confirmed in the treatment of 19 wounded (2 - with standard laparoports, 17 - with the silicone port), which avoided pain and risk of additional trauma to the abdominal organs, to conduct a re-audit of the abdominal cavity at the following levels of care. Widespread introduction of endovideosurgical technologies in the treatment of wounded with combat injuries at the II-IV levels of medical care has avoided unwarranted traumatic interventions, earlier activation of the wounded, reduce inpatient treatment and return the wounded to service earlier than traditional treatments.