Secania T., Sorochin L., Bahnarel D.
The Endoscopic and Mini-invasive Surgery Service,
The Republican Hospital of the State Chancellery of the Republic of Moldova
The work was developed based on the research carried out at the Department of Forensic Medicine, Chisinau and the Chair of Topographic Anatomy of the State Medical University and Pharmacy "N. Testimitseanu", Chisinau. This is a topical issue since, medical staff from the very beginning of their activity in interventional ecography face a series of difficulties that can lead to complications (from insignificant to serious ones that require surgical intervention).
The study aimed at obtaining practical skills, modeling and documenting (recording) the complications that may emerge as a result of ecoguided transcutaneous interventions.
Materials and methods
Instruments like the Chiba needle, trocars of different diameters, catheters, incision lancets have been used in the experiment. A punction and drainage according to the Seldinger and trocar-catheter methods were conducted.
Complications like the trauming of the liver with the emergence of a hematoma and hemorrhage have been modeled, as well as the passing of the trocar-catheter through the pleural sinus in case of ecoguided cholecystostomy or ecoguided drainage of the liver abces, which in case of simultaneous pathologies (ascitys, pleuritys) can cause additional complications (infection of liquid, etc.). In the application of ultrasonically transcutaneous transhepatic cholecystostomy and in the hepaticostomy in the result of partial movement of the drain with the orifices over the liver there emerges the leaking of bile in the abdominal cavity with possible development of local or diffuse peritonitis. The same complications emerge in the result of the perforation of the gallbladder with the trocar-catheter and placement of the drain in the abdominal cavity (subhepatic). Thus, in the result of the draining of the gallbladder not transhepatically but directly through the bottom of the gallbladder using
a direct drain instead of a "pig tail" one, it can cause the misplacement of the drain with further respective complications. A correctly drained hepatic abscess can be followed by complications in case of partial movement of the orifices above the liver and leakage of the purulent content from the abdominal cavity.
In the transcutaneous transgastric punction of the Wirsung duct we can obtain hematoma and other conditions.
A compulsory requirement in the ultrasonically guided percutaneous investigations is the permanent visualization of the needle tip on the display. However, practice shows the importance of operator's experience in determining tissue's resistance on the trajectory of the punction (drainage).
When using the samples with liquid in the process of invasive investigation we can avoid such complications as the perforation of the small bowel, colon directing the trocar along these important organs.
The modeling of different diseases carried out under the experiment, gaining of practical skills in punctioning and drainage and in determining tissue's resistance on the trajectory of the ultrasonically guided investigation contributes to the obtaining of experience and knowledge necessary for the treatment of diseases with severe and combined pathologies, to the patients with past surgical interventions on the abdominal cavity, when ultrasonically percutaneous punction and drainage can be the sole method of diagnosis and treatment.