CALCULATION OF OPTIMAL TROCAR INSERTION ZONES DURING NISSEN AND TOUPET LAPAROSCOPIC SURGERY
Keywords:
laparoscopic fundoplication, Nissen, Tupe, body types, body mass index, optimal trocar insertion zones.Abstract
Purpose: to determine the optimal trocar insertion zones for performing Nissen and Tupe physical therapy, taking into account the physique of patients. Research materials and methods. The results of the examination of 224 patients with hiatal hernia (HH) who were inpatient treatment at the multidisciplinary clinic of the Tashkent Medical Academy in the period from 2012 to 2024, who underwent Nissen and Toupet physical therapy, were analyzed. All patients were divided into two clinical groups. The control group included 105 patients who underwent standard Nissen or Toupet physical therapy. In the main group of 119 patients, when performing physical therapy, the trocar injection points were determined according to the calculations of a computer program developed by us. Among the operated patients, 125 (55.8%) had axial HH (type I), 21 (9.38%) had paraesophageal (type II), 67 (29.91%) had mixed (type III), and 11 (4.91%) had type IV. There were 115 (51.34%) women and 109 (48.66%) men. The age of the patients ranged from 18 to 76 years (the average age was 52.5±3.8 years). Their average BMI was 32.2±2.5 kg/cm2. In the control and main groups, the number of patients with normosthenic physique was 33 and 40, respectively, with asthenic - 13 and 20, and hypersthenic – 59 each. Results: In the control group, the duration of physical therapy in patients with normosthenic and asthenic physique was on average 125±15 minutes, with hypersthenic - 185±27 minutes (on average in the control group - 170±22 minutes). In the latter, the lengthening of the LFP duration is associated with difficulties in creating a retroesophageal "window" and poor visualization of the fundus of the stomach through previously installed trocars at standard points. In 4 (25%) cases, trocars were reinstalled intraoperatively in patients with hypersthenic physique. In the main group, the optimal parameters for the introduction of trocars and working tools were determined before the physical therapy according to the program we developed. Based on the determination of the optimal points of trocar administration in the main group with normasthenic and asthenic physique, the duration of exercise therapy was on average 110±10 minutes, with hypersthenic – on average 140±14 minutes (on average in the main group - 125±12 minutes). At the same time, in patients with a BMI of more than 30 kg/cm2, the duration of the operation was reduced by 45 minutes. Conclusion: Performing LFP according to Nissen and Tupe using standard points of insertion of instruments, especially with hypersthenic physique, presents certain difficulties and is, as a rule, the cause of intraoperative complications and prolongation of the duration of the intervention. The proposed program makes it possible to determine the most optimal points of trocar insertion during Nissen and Tupe physical therapy, depending on the patient's body type, which helps to reduce the number of intraoperative complications and shorten the duration of surgery.
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