OBJECTIVE
To assess the level of illumination of hard-to-reach places of thoracic and abdominal cavities by traditional instruments and to developand compare the effectiveness of original illuminators.
MATERIAL AND METHODS
The level of illumination was determined by a luxmeter. Indicators were registered in the following deflected areas: right (supra- and subhepatic), left subdiaphragmatic spaces, esophageal-gastric transition zone, right and left lateral canals, lesser pelvis, right rib-mediastinal sinus. Traditional instruments were used for illumination: ceiling fixation lamp, head illuminator, endoscopic illuminator (optical tube), retractor with built-in light guide. Measurements were made in the operating room of a surgical profile on a mock-up (3B SCIENTIFIC), and in the sectional hall of the Bureau of forensic medicine (Minutes of the meeting REC, on Dec. 26—22.) on 17 not fixed corpses (8 male and 9 female), died aged 42 to 67 years from diseases of the chest and abdominal cavities affecting pathologies (6 — brachymorphic, 6 — mesomorphic, 5 — dolichomorphic). We performed right lateral thoracotomy at 5 intercostal space (size 15—18 cm) and upper, middle, lower midline laparotomy (size 20—25 cm). Wound depths ranged from 10.3 cm to 29.6 cm, depending on body type. Light values were measured under similar conditions by designed original instruments with LED coating on the working part (retractors: flexible-elastic, wire, for «mini access»; renal mirror, tip for aspiration).
RESULTS
The lowest illumination values of the sloping places were obtained for ceiling-mounted lamps (816.81±163 lux). The next in value is for the headlamp illuminator (11873.8±112.9 lux). The indicators of flexible-elastic and wire retractors with LED illuminators (17316.4±79.4 lux and 17224.8±82 lux) are comparable with the maximum values of an endoscopic illuminator (optical tube) (17367.3±18.7 lux) and a retractor with a fixed light guide (17268.1±31.6 lux). In comparison with the previous one there was a slight decrease in the results of maximum illumination for the renal mirror (16262.4±80.5 lux) and the retractor for mini access (15316.2±81.3 lux). This is due to the smaller number of LED elements on the working part, but when using the original tip for aspiration, the indicators increase and the difference is leveled. In the zones of extreme remoteness of a specific anatomical area, the illumination indicators of all original retractors decrease slightly and significantly exceed those for traditional illuminators. The angle of incidence of the light flux from the original instruments in relation to the axis of operation is always less than 50 °, which, in combination with the matte surface of the retractors, eliminates visual discomfort (glare) for the operating team.
CONCLUSION
The developed original retractors with LED illuminators on the working part of the instruments provide optimal illumination of the thoracic and abdominal cavities, comparable to the best indicators of traditional light-guided instruments and surpassing those of ceiling lamps and head illuminators; they combine ergonomics and functionality that can qualitatively improve the ability to perform surgical interventions on the organs of the hollow spaces in open thoraco-abdominal surgery.
