[LASER TECHNOLOGIES IN LAPAROSCOPIC HERNIOLOGY]

Abstract

Objective - to analyze the expediency of using a universal laser coagulator "Lika-surgeon" with a wavelength of 1470 nm as an alternative to an electrocoagulation while performing dissection for TAPP. The work is based on the analysis of 88 TAPP patients, using a universal laser "Lika-surgeon" with a wavelength of 1470 nm at a radiation power of 10-12.5 W and 102 patients operated according to the trivial standard TAPP procedure, where an electrocoagulation hook with a coagulation and cutting power of 35 W is used as a dissection instrument. Evaluation considered the criteria of operating time, duration of hospital stay, severity of pain syndrome, morphological assessment of the prevalence of laser and electrical effects on the tissues in the affected area.. All surgical interventions were performed in the Department of General and Vascular Surgery of the PNCO "Kyiv City Hospital №1, Shalimov's National Institute Of Surgery And Transplantation National Academy Of Medical Sciences Of Ukraine and Republican Clinical Hospital Of Batumi in 2020. The cutting mode in an electrosurgical apparatus is accompanied by tissue wrinkling and smoke in the operating field. The laser device is devoid of these disadvantages. At the same time, laser coagulation requires practical skills of the operator to select the optimal distance between the optical fiber and the object. The operating time and the duration of hospital stay in patients of the first group are significantly shorter. The severity of pain in the early postoperative period was comparable in both groups. In the late postoperative period, the pain syndrome was more severe in the second group - it accompanied 6.1% of patients in the first group and 15.2% in the second group. Analysis of the morphological material showed significantly less tissue trauma in the affected zone in the first group - the coagulation zone is 372.91 µm versus 835.88 µm in the second group. A laser coagulator with a wavelength of 1470 nm has a number of significant advantages over an electrosurgical coagulator: more efficient cutting and coagulation modes; optical clarity of the operating field; minimal thermal damage of the underlying tissues (the depth of tissue damage in the first case is 166.36 microns, in the second 835.88 microns); significant reduction of operating tine and the duration of hospital stay; significant reduction of pain in the postoperative period. This opens up new perspectives for its use in laparoscopic surgery of inguinal hernia.