Pilecki Zbigniew1, Pilecki Grzegorz1, Bubnov Rostyslav2, Abdullaiev Rizvan3
1Sports Medicine Center in Zabrze, Poland
2Clinical Hospital ”Pheophania“ of State Affairs Department, Kyiv, Ukraine
3 Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine

Key words. Operative ultrasonography, sonosurgery, sonotopogram, patient safety, personalized medicine, EPMA.

Introduction. The dynamic development of minimally invasive techniques in surgery was based on access to imaging equipment, endoscopic sets and surgeons huge passion. It is a great imagination, responsibility and courage of surgeons was the driving force increasing use of minimally invasive techniques. Looking back on the development of surgery we can conclude that this discipline is developing in the direction for minimizing damage during the intervention. This is the reason for the development of minimally invasive techniques in surgery. With the appearance of opportunities imaging in real time conditions were created for the performance of invasive procedures in ultrasound imaging. As a first evolved puncture techniques, which became the starting point for the development of sonosurgery. [1, 2]

Sonosurgery . Sonosurgery is a collection of minimally invasive surgical techniques performed with continuous ultrasound imaging and the use of endoscopic tools. It’s a surgical discipline and requires compliance of aseptic and medical art conditions and should be performed in the operating unit by experienced personnel. By medical art we understand mastery in surgical techniques and ability to perform ultrasound examination by a physician. However, the simplicity and minimal tissue trauma during sonosurgical procedures will lead to execute them in operating room similar to procedures in interventional ultrasonography [3]. Sonosurgical techniques are techniques performed in the conventional surgery and orthopedics, but the use of ultrasound equipment can reduce operating approach and reduce invasive procedure to the affected tissue. The use of proven surgical techniques used in minimally invasive surgery is desirable, because it does not fill signs of a medical experiment. Widespread is the use of prepared sets [4]. Simplifying the idea of sono-surgery we can say that we do not need to cut through the operated tissue for surgical supply, because we can see it perfectly in the ultrasound image. We see more than the naked eye, we can zoom in, use the Doppler, contrast, elastography, or motion. To understand progress what was made in minimally invasive surgery we present operating options used in the supply of Calcaneal tendon damage by coblation using Topaz electrode. The strength of sonosurgery lies in the phenomenon of complementarity, which is supplementation of the various stages of sonosurgical procedure by each other. Logic of such proceedings during surgery allows it to make it simple and friendly for the surgeon and patient.

Stages in sonosurgical procedures .
We perform sonosurgery successfully for three years systematically increasing range of operations. All procedures in sonosurgery have their steps, which we will present:
I. Performing of a sonotopogram; II. Preparations techniques: 1) Using liquid (needle technique); 2) Using tools; 3) Using electrotools; 4) Balloon techniques; 5) Mixed techniques; III. Endoscopic tools; IV. Sewing.

Conclusions. Use of ultrasound imaging allows a very precise, atraumatically and aseptically perform surgery. Surgery pefromed in sonosurgical technique has all the characteristics of minimall invasive treatment: good cosmetic result, minimall tissue trauma, low pain, the possibility of taking early rehabilitation and a very good final result. An essential element of any medical procedures are the costs of its implementation, which are systematically counted. The total cost of sonosurgical treatment, compared to procedures performed in classical techniques is low, because of minimal amount of materials used for the treatment, the number of staff and the way of anesthesia. Operations are performed in one-day procedure. The cost of ultrasound imaging amortization is low. Using ultrasound imaging, we can often control the course of healing of the operated structures. This is not a threat to the patient and the costs are also low. We are able, based on ultrasound images to determine the effectiveness and the time needed to heal the sick organ, which is enormous practical information. We are always concerned when we write about medical procedures only in superlatives, as in this article. But sonosurgery is exactly this. The only downside, which we should pay attention again is high hardware requirements and very experienced surgical team. We want to emphasize once again at the end strongly that the ultrasound device should be available in every operating room and handled by an experienced physician. This is necessary if we want to build safe and modern hospital [5].

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