Optical Ports Research Articles

A Successful Laparoscopic Appendectomy for an Adult Male Patient with Osteogenesis Imperfecta.

Osteogenesis imperfecta (OI) is a genetic connective tissue disease defined by the loss of bone mass and density, which makes the bones more brittle and more likely to fracture over time. Bone deformity and articular instability are the subsequent symptoms. This 25-year-old man had malformed lower limbs and trouble walking due to OI and dwarfism. He arrived complaining of fever, nausea, vomiting and diffuse peri-umbilical pain. During ultrasonography a blinded, oedematous lobe formation containing an appendicolith was discovered. Acute suppurative appendicitis was diagnosed, necessitating a laparoscopic appendectomy. Because the patient had previously undergone general anaesthesia, anaesthesia was thought to be attainable. Pneumoperitoneum and a 10 mm optical port inserted into the umbilicus were used in the surgical procedure. A diagnostic laparoscopy revealed faecolith obstruction and an acute suppurative appendicitis. After an hour, a laparoscopic appendectomy was performed effectively with little blood loss. Without experiencing any difficulties because of the surgery position, the patient was discharged. We present a case of an OI dwarf patient with acute suppurative appendicitis. It highlights the possibility of performing laparoscopic surgery in general and a laparoscopic appendectomy in particular on OI patients. In rare instances involving OI, laparoscopic surgery in general and laparoscopic appendectomy in particular are practical and efficient options.

Following fuel conversion during biomass gasification using tunable diode laser absorption spectroscopy diagnostics

The efficiency of the gasification process and product quality largely depend on the degree of fuel conversion. We present the real-time in-situ tunable diode laser measurements of main carbon and oxygen-containing species in the hot reactor core of a pilot-scale entrained flow biomass gasifier (EFG). The concentrations of CO, CO2, CH4, C2H2, H2O, soot, and gas temperature were measured during the air and oxygen-enriched gasification of stem wood at varying equivalence ratios. The experiments were made at the upper and lower optical ports inside a 4 m long, ceramic-lined, atmospheric EFG, allowing to access the degree of the fuel conversion inside the reactor. The exhaust composition was measured by micro-GC, FTIR, and low-pressure impactor. There was a good agreement between the data measured inside the reactor and at the exhaust for oxygen-enriched gasification implying that the chemical reactions are practically frozen downstream the optical ports. For air, the data indicated that the gasification reactions are still active at the measurement locations. Significant concentrations of C2H2, up to 5000 ppm, were found inside the reactor.

Optimizing elastic optical networks quality of transmission with an empirical optical amplifier gain saturation model

In this paper, we revisit the problem of adjusting transceiver power, amplifier gain, and nodal gain in optical-bypass-enabled networks, taking into account an empirical model of erbium-doped fiber amplifier (EDFA) gain saturation. We assume that network demands have been routed via the shortest possible paths. A heuristic algorithm, which estimates the degradation of the signal-to-noise ratio (SNR) for each demand, is used to assign the modulation level and spectrum slots to the routed demands. Our optimization process aims to maximize the minimum SNR margins of demands, by adjusting EDFA small-signal gain, variable optical attenuator (VOA) attenuation, and transceiver power. Constraints and impairments imposed by the physical-layer include EDFA and VOA gain limits, transceiver power limits, receiver sensitivity, insertion loss of optical switch input ports, EDFA gain saturation, EDFA noise, and fiber non-linear interference. These are modeled using the Gaussian noise model. The proposed optimization problem is formulated as a geometric programming problem and then converted into an equivalent convex problem.Numerical results suggest that in the optimal solution of our optimization, all demands are served with typically low bit error rates (BER) (<10−4). We calculate the operational gains of the EDFA to set the spans to full compensation whenever possible. Pre-amplifiers and line amplifiers do not experience gain saturation due to relatively small input powers, while approximately 10% of boosters undergo more than a 1 dB gain reduction due to high input powers. We observe that overlooking the effect of EDFA gain saturation and physical-layer-imposed constraints such as nodal gain limits or transceiver power limits during network optimization leads to a considerable number of blocked demands due to SNR degradation or high BER (>10−3).

Adaptive Generalized Time Interval Cumulative Methodology for Optical Port Degradation Modeling in Cloud Computing Service

Adaptive Generalized Time Interval Cumulative Methodology for Optical Port Degradation Modeling in Cloud Computing Service

SURG-10. DEVELOPMENT OF 2 COMPLEMENTARY INNOVATIVE APPROACHES FOR REAL-TIME, LABEL-FREE INTRAOPERATIVE TUMOR DETECTION TO ENHANCE EXTENT OF RESECTION OF LOW GRADE GLIOMAS

Abstract Brain tumor surgery aims to maximize tumor resection while avoiding neurological deficits. Accurate characterization of tissue and delineation of resection margins are essential to achieve optimal surgical outcome. Hyperspectral imaging (HSI) and Real-time Rapid Evaporative Ionization Mass Spectrometry ( REIMS) are both novel technological adjuncts able to accurately detect intraoperatively zones of low grade glioma without substantially altering the surgical work flow. For HSI, we successfully demonstrate how an HSI system can interface with a clinically approved surgical microscope making use of the microscope’s available light sources and optical ports. We integrated the HSI system into the clinical workflow during brain surgery, specifically for resections of low-grade gliomas (LGG). During the study the acquired dataset was used to train an AI algorithm to detect LGG, providing 81% accuracy on unseen data. Real-time Rapid Evaporative Ionization Mass Spectrometry (REIMS) enables in-situ tissue characterization based on the mass spectrometric analysis of electrosurgical vapors generated during dissection. We demonstrate the use of REIMS for the molecular characterization of brain tumor tissue, thereby providing quasi real-time assessment of tumor type. A classification model containing 31 sampling points in normal brain tissue and 93 in glial tumor tissue provided 89.3% sensitivity and 91.1% specificity. Both techniques, HSI and REIMS display a high intraoperative diagnostic accuracy in terms of glioma tissue detection and are complementary, real-time and label-free methods which we developed and tested up to the stage of high Technology Readiness levels (TRL) of 7 and 5 respectively.

Self-configuring programmable silicon photonic filter for integrated microwave photonic processors

Reconfigurable photonic filters show great promise as a potential solution to meet the evolving needs of future microwave communication systems. By integrating high-performance filters into programmable microwave photonic processors, they can provide significant benefits for signal processing applications. The development of an algorithm that can automatically characterize and reconfigure the filter using a single optical input and output port is essential for this purpose. This paper presents an optimization technique for a fully tunable ring-assisted Mach–Zehnder interferometer filter. The proposed filter design eliminates the need for monitoring components and employs a novel algorithm that operates independently in each ring by switching between the two arms of the filter. In addition, the filter can be configured to implement different filter architectures, allowing for flexible filtering requirements. Measurements were performed using the device as an interleaver, implementing different types of infinite impulse response filters in the optical and radio frequency domains. Side-coupled integrated spaced sequence of resonator filters were also implemented by reconfiguring the same device. These results demonstrate the exceptional reconfigurability of the filter design proposed herein in terms of bandwidth and central frequency.

Modified optical port entry site for laparoscopic cholecystectomy: Our experience.

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; The four-port laparoscopic cholecystectomy is a recognized entity in the surgical management of gallstone disease. We report our experience and feasibility of optical port entry site modification.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Material and Methods:&lt;/b&gt; To assess the feasibility and safety of laparoscopic cholecystectomy with a different port placement, we undertook a prospective study with 60 patients at Seth GSMC and KEM Hospital, India between Jan 2022 and July 2022. Our study offered the benefit of a flexible optical port entry site, using a 5 mm optical trocar instead of the conventional 10 mm trocar. A single surgeon did all the cases and definite criteria of simple cases of gallstone disease patterned on clinical and radiological grounds.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; 60 cases of gallstone disease were subjected to the new technique of laparoscopic cholecystectomy over seven months. 39 cases were females and 21 were males. The age range of our patients was between 20 and 55 years with a median age of 39 years. Mean Body mass index 30 (range 25 - 37). The mean operative time was 30 min (range 15 - 45 min) and a follow-up period ranged from 10 to 14 months. No cases were converted to open. We did not encounter any untoward mishaps during surgery.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Discussion:&lt;/b&gt; Our modification of the optical port placement and size received good results and patient satisfaction. Moreover, the placement of the port at a site further from the midline and umbilicus decreases the risk of development of trocar site incisional hernia.&lt;/br&gt.

325 Modified Abdominal Assess for Laparoscopic Cholecystectomy in Obese Population: Our Recommendation

Abstract Background and Aim Conventional Umbilical access can be time consuming, surgically challenging due to inadequate ‘Critical View of Safety’ and pneumoperitoneum maintenance for high BMI patients undergoing laparoscopic cholecystectomy (LC). Assess the feasibility, safety and outcome of our modified access for patients of BMI ≥30. Method and Technique Prospective study of consecutive patients undergoing LC in a large DGH (2007-2022) that included age, sex, BMI, ASA, grade of operation with stay and complications were analysed. Group A: Veress needle pneumoperitoneum through Palmer’s point. After 2 litre (minimum) insufflations, optical port introduced at intersection of two imaginary lines: a 15cm oblique line starting from where the right mid-clavicular line cuts the right lower costal margin and directed medially meeting the other vertical line running 3cm to the right of midline. Remaining ports standard. Group B (BMI &amp;lt;30): Conventional umbilicus entry. Results Group A: 543 with Female: Male 4:1 (436:107), Age 49* (16-82) years, BMI 36*(30-65), ASA 2 * (1-3), Grade 1 * (1-4), Operating time 50* (15-200) mins, PO stay 0* (0-15) day. One conversion, 2 bile leaks, 5 collections and 4 wound infections. Group B: 1168 with Female: Male 3:1 (861:307), Age 53* (16-89) years, BMI 26 * (17-29), ASA 2* (1-3), Grade 1* (1-4), Operating time 45 *(15-240) mins, PO stay 0* (0-12) day. Ten conversions, 3 bile leaks, 5 collections, 8 wound infections, and 6 wash outs. Conclusion Modified LC abdominal access for obese patients allows safe quick entry with excellent ‘Critical view of Safety’ for a good outcome. * Median

In-plasma analysis of plasma–surface interactions

During deposition, modification, and etching of thin films and nanomaterials in reactive plasmas, many active species can interact with the sample simultaneously. This includes reactive neutrals formed by fragmentation of the feed gas, positive ions, and electrons generated by electron-impact ionization of the feed gas and fragments, excited states (in particular, long-lived metastable species), and photons produced by spontaneous de-excitation of excited atoms and molecules. Notably, some of these species can be transiently present during the different phases of plasma processing, such as etching of thin layer deposition. To monitor plasma–surface interactions during materials processing, a new system combining beams of neutral atoms, positive ions, UV photons, and a magnetron plasma source has been developed. This system is equipped with a unique ensemble of in-plasma surface characterization tools, including (1) a Rutherford Backscattering Spectrometer (RBS), (2) an Elastic Recoil Detector (ERD), and (3) a Raman spectroscopy system. RBS and ERD analyses are carried out using a differentially pumped 1.7 MV ion beam line Tandetron accelerator generating a beam at grazing incidence. The ERD system is equipped with an absorber and is specifically used to detect H initially bonded to the surface; higher resolution of surface H is also available through nuclear reaction analysis. In parallel, an optical port facing the substrate is used to perform Raman spectroscopy analysis of the samples during plasma processing. This system enables fast monitoring of a few Raman peaks over nine points scattered on a 1.6 × 1.6 mm2 surface without interference from the inherent light emitted by the plasma. Coupled to the various plasma and beam sources, the unique set of in-plasma surface characterization tools detailed in this study can provide unique time-resolved information on the modification induced by plasma. By using the ion beam analysis capability, the atomic concentrations of various elements in the near-surface (e.g., stoichiometry and impurity content) can be monitored in real-time during plasma deposition or etching. On the other hand, the evolution of Raman peaks as a function of plasma processing time can contribute to a better understanding of the role of low-energy ions in defect generation in irradiation-sensitive materials, such as monolayer graphene.

Universal wavelength reuse mechanism for optical networks-on-chip based on a cooperative game

Optical networks-on-chip (ONoCs) based on wavelength division multiplexing (WDM) technology have lower end-to-end (ETE) delay, larger bandwidth, and higher throughput than NoCs. However, the utilization and parallelism of individual wavelengths are essential since WDM technology would require more optical devices to be integrated with ONoCs, leading to higher on-chip overhead. In this paper, we propose an optimal model of communication node cooperation based on game theory, in which the loss of the optical signal on the transmission path for a specific optical receiver sensitivity establishes the payoff function of each participant. In this cooperative game model, the communication nodes are regarded as the participants of the cooperative game. By analyzing the principle of optical router port occupation, the coordinate-based coalition assignment algorithm is proposed to implement fast construction of coalitions and reach the Nash equilibrium of the cooperative game. In Nash equilibrium, the utilization and parallelism of individual wavelengths are higher, and the network’s performance is optimized and improved. Cooperative-game-based ONoCs have more significant throughput and lower ETE delay. The optical signal loss and minimum output power of the optical transmitter can be further reduced at a given optical receiver sensitivity. By applying the cooperative game to ONoCs, the network’s optimization effect becomes more evident as the network scale increases and the number of communication nodes grows.

Mixture formation characteristics and feasibility of methanol as an alternative fuel for gasoline in port fuel injection engines: Droplet evaporation and spray visualization

Under the background of energy saving and emission reduction, methanol is considered an ideal alternative fuel for gasoline because of its renewability, high combustion efficiency and low emissions, while an issue is the cold start of methanol port fuel injection engines. To comprehensively understand the underlying mechanisms and the feasibility of methanol as a substitute of gasoline, a suspension method was first used to investigate the evaporation characteristics of methanol and gasoline droplets at low temperatures. Then an optical intake port was constructed based on the outer contour modification strategy and an optical distortion correction algorithm was proposed. The effects of inlet temperature, inlet flow rate and injection pressure on spray characteristics of methanol and gasoline were comparatively investigated. In addition, the influence of valve temperature on the characteristics of spray impingement on a valve was studied. The results showed that the difference between the evaporation rates of methanol and gasoline was small at 60–90 °C. The difference became obvious when the temperature was below 60 °C or above 90 °C. Reducing the ambient humidity may reduce this difference and improve the cold start performance of methanol engines. A higher inlet temperature slightly increased the spray area. A higher inlet flow rate and injection pressure significantly increased the spray area, but also caused serious wet wall problem. From the point of view of spray in the port, methanol was a feasible substitute for gasoline in the presence of inlet flow and at low injection pressure of 6 bar. The valve temperature should exceed 200 and 230 °C for methanol and gasoline, respectively to form vapor films that prevent fuel adhesion onto the valve. However, methanol may not be a suitable alternative fuel for gasoline when spray directly impacted on the valve in port fuel injection engines due to its much smaller spray area.

A 220 GHz-1.1THz continuous frequency and polarization tunable quasi-optical electron paramagnetic resonance spectroscopic system.

Here, we describe a custom-designed quasi-optical system continuously operating in the frequency range 220GHz to 1.1THz with a temperature range of 5-300K and magnetic fields up to 9T capable of polarization rotation in both transmitter and receiver arms at any given frequency within the range through a unique double Martin-Puplett interferometry approach. The system employs focusing lenses to amplify the microwave power at the sample position and recollimate the beam to the transmission branch. The cryostat and split coil magnets are furnished with five optical access ports from all three major directions to the sample sitting on a two-axes rotatable sample holder capable of performing arbitrary rotations with respect to the field direction, enabling broad accessibility to experimental geometries. Initial results from test measurements on antiferromagnetic MnF2 single crystals are included to verify the operation of the system.

Behavior of Premixed Sooting Flame in a High-Pressure Burner

The second-order factor effect of burner optical ports and edge inter-matrices (EIM) and the first-order factor of pressure on the soot formation process and behavior of premixed sooting flames in a high-pressure burner are numerically investigated here. Three-dimensional computational fluid dynamics (CFD) simulations of a premixed flame C2H4/air at p = 1.01 and 10 bar using a one-step chemistry approach are first performed to justify the satisfied predictability of the prospective axisymmetric two-dimensional (2D) and one-dimensional (1D) simulations. The justified 2D simulation approach shows the generation of an axial vorticity around the EIM and axial multi-vorticities due to the high expansion rate of burnt gases at the high pressure of 10 bar. This leads to the development of axial multi-sooting zones, which are manifested experimentally by visible luminous soot streaks, and to the boosting of soot formation conditions of a relatively low-temperature field, &lt;1800 K, and a high mixing rate of gases in combustion around and above the EIM location. Nevertheless, a tolerable effect on the centerline soot volume fraction (fV) profile, fV &lt; 3%, is manifested only at high heights above the burner of the atmospheric sooting flame C2H4/air ϕ = 2.1, and early at the high pressure of 10 bar of this flame, fV &lt; 10%. Enhancing the combustion process reactivity by decreasing the rich equivalence ratio of the fuel/air mixture and/or rising the pressure results in the prior formation of soot precursors, which shifts the sooting zone upstream.

Numerical Study and Experimental Verification of Biomass Conversion and Potassium Release in a 140 kW Entrained Flow Gasifier.

In this study, a Eulerian-Lagrangian model is used to study biomass gasification and release of potassium species in a 140 kW atmospheric entrained flow gasifier (EFG). Experimental measurements of water concentration and temperature inside the reactor, together with the gas composition at the gasifier outlet, are used to validate the model. For the first time, a detailed K-release model is used to predict the concentrations of gas-phase K species inside the gasifier, and the results are compared with experimental measurements from an optical port in the EFG. The prediction errors for atomic potassium (K), potassium chloride (KCl), potassium hydroxide (KOH), and total potassium are 1.4%, 9.8%, 5.5%, and 5.7%, respectively, which are within the uncertainty limits of the measurements. The numerical model is used to identify and study the main phenomena that occur in different zones of the gasifier. Five zones are identified in which drying, pyrolysis, combustion, recirculation, and gasification are active. The model was then used to study the transformation and release of different K species from biomass particles. It was found that, for the forest residue fuel that was used in the present study, the organic part of K is released at the shortest residence time, followed by the release of inorganic K at higher residence times. The release of inorganic salts starts by evaporation of KCl and continues by dissociation of K2CO3 and K2SO4, which forms gas-phase KOH. The major fraction of K is released around the combustion zone (around 0.7-1.3 m downstream of the inlet) due to the high H2O concentration and temperature. These conditions lead to rapid dissociation of K2CO3 and K2SO4, which increases the total K concentration from 336 to 510 ppm in the combustion zone. The dissociation of the inorganic salts and KOH formation continues in the gasification zone at a lower rate; hence, the total K concentration slowly increases from 510 ppm at 1.3 m to 561 ppm at the outlet.

SpectIR-fluidics: completely customizable microfluidic cartridges for high sensitivity on-chip infrared spectroscopy with point-of-application studies on bacterial biofilms.

We present a generalizable fabrication method for a new class of analytical devices that merges virtually any microfluidic design with high-sensitivity on-chip attenuated total reflection (ATR) sampling using any standard Fourier transform infrared (FTIR) spectrometer. Termed "spectIR-fluidics", a major design feature is the integration of a multi-groove silicon ATR crystal into a microfluidic device, compared with previous approaches in which the ATR surface served as a structural support for the entire device. This was accomplished by the design, fabrication, and aligned bonding of a highly engineered ATR sensing layer, which con```tains a seamlessly embedded ATR crystal on the channel side and an optical access port that matched the spectrometer light path characteristics at the device exterior. The refocused role of the ATR crystal as a dedicated analytical element, combined with optimized light coupling to the spectrometer, results in limits of detection as low as 540 nM for a D-glucose solution, arbitrarily complex channel features that are fully enclosed, and up to 18 world-to-chip connections. Three purpose-built spectIR-fluidic cartridges are used in a series of validation experiments followed by several point-of-application studies on biofilms from the gut microbiota of plastic-consuming insects using a small portable spectrometer.

STUDY OF ERGONOMICS IN LAPAROSCOPIC CHOLECYSTECTOMY BY CHANGING EPIGASTRIC PORT SITE IN RELATION TO FALCIFORM LIGAMENT

Background- In the present era Laparoscopic cholecystectomy has established as the gold standard to open cholecystectomy. It is proved that one of the commonest causes among stressful minimal access surgery is wrong port position, even if one port is at wrong place or not following laws of ergonomics. In this study, we have study of ergonomics in laparoscopic cholecystectomy by changing epigastric port site in relation to falciform ligament A total of 40 patients, 20 in each conventional and 20 Methodusing our modied epigastric port site laparoscopic cholecystectomy was performed and ergonomics was measured in terms of azimuth angle, manipulation angles and baseball eld concept. The angle of manipulation in our Result- cases was 60 degree (vs 105 degree in control). Azimuth angle was 30 degree (vs 80 degree). Distance between optical and epigastric port is on average 5.7.5 cm (vs 14-16 cm) and distance between target and epigastric port is on average 12-15 cm (vs 6-7 cm). Above ndings are following principles of ergonomics In LC, epigastric port Summarywhen inserted to the left of falciform ligament gives better ergonomics integration in terms of manipulation angle, azimuth angle than from right of ligament. providing better freedom of movement, precision and also reduce physical strains on the surgeon plus increases productivity intraoperatively following baseball eld concept.

ANALYSIS OF IN-CYLINDER FLOW FIELDS USING PROPER ORTHOGONAL DECOMPOSITION-BASED QUADRUPLE DECOMPOSITION

In order to meet increasingly stringent emission norms coupled with a heightened requirement of performance, there has been an unabated effort toward improvement in the combustion process of modern internal combustion engines. One of the major impediments of enhanced combustion in spark-ignited port fueled engines are combustion variations. These variations are especially dominant at low-load, low-speed operations. Cycle-to-cycle variation (CCV) in in-cylinder flow fields is one of the major contributors of such combustion variations. Therefore, in this work, CCV of in-cylinder flow fields of an optical port fuel injection engine was analyzed at part load (50&amp;#37; throttle opening) and low speed (1200 rpm) with the help of proper orthogonal decomposition. Flow fields were subsequently decomposed into four components, namely, mean, coherent, transition, and turbulent parts. CCV of flow fields was studied using several metrics based on kinetic energy and the relevance index. It was found that the share of mean energy is a better metric for CCV quantification based on kinetic energy. Interestingly, it was observed that the mean part, though consistent in its flow structure for various cycles, has a lot of variation in kinetic energy at early compression stroke. Also, a weak mean flow coupled with a strong coherent flow structure opposing the mean flow produces the largest deviation in a flow field from its corresponding ensemble-averaged field. Furthermore, even though the coherent and transition parts are comprised of comparable energy, it was the coherent part that showed large variations in kinetic energy. Hence, the mean and coherent parts are mainly responsible for CCV in flow fields.

100 kW electron-beam high heat flux test facility for testing EAST and CFETR divertor components

A 100 kW electron-beam (EB) high heat flux (HHF) test facility, named after Hefei Electron-beam high heat Flux Test facility, or HEFT for short, has been constructed in Institute of Plasma Physics Chinese Academy of Sciences (ASIPP) in order to test EAST divertor plasma facing components (PFCs) and CFETR small scale testing mock-ups. HEFT is equipped with a domestic EB gun with a maximum output power of 100 kW. The electron current exceeds 3 A at the maximum acceleration voltage of 35 kV. Equipped with a beam deflection system with scanning frequency of 10 kHz and maximum beam deflection angle of ± 7° at 35 kV, the device provides a more uniform heat flux on the plasma facing units (PFUs). The vacuum chamber, which provides high vacuum environment for HHF test, can be pumped to 1 × 10−3 Pa. There is one installation port for EB gun and four installation ports for optical diagnostic system on the top of the vacuum chamber. In order to monitor the sample surface effectively, the four optical diagnostic ports are arranged around the EB gun port and are all at a 15°angle to the axis of the EB gun port. The maximum parameters of the cooling water system are inlet flow of 15 m3/h, inlet pressure of 2 MPa, inlet temperature of 20°C.

O-232 Art of fibroid removal in patients with infertility

Abstract Aim of myomectomy in infertile patient is to preserve and improve fertility, minimising excessive bleeding and pain. Relation ship of myoma and fertility remains debatable moreover removal of all myomas may not be helpful in improving fertility outcome thus it becomes important to decide which fibroid should be removed and which one shouldn’t be touched. Principle of minimal damage and complication should be kept in mind. Mapping of fibroid is an important step in planning the route of operation.Number and site of myoma decides the approach. A preoperative meticulous TVS examination supplemented by TAS specially in large and multiple fibroids is extremely helpful in decision making. it is also important to preoperative differentiation of adenomyosis and fibroid to avoid a surprise element and excessive bleeding during removal. Use of colour flow may be helpful in differentiating. Use of 3-D is important specially in borderline sub mucous myoma. Extent of myoma in to uterine cavity is very important to decide the route of operation. various classifications have attempted to simplify the decision making but combining usg and hysteroscopy is the best way to decide. it is also important to diagnose a large intramural myoma touching the junctional zone. Instilling methylene blue before operation to outline the cavity during surgery in case of accidental entry is a good practice. using intraoperative ultrasound while tackling a large intracavitary fibroid having more than 75% extent in intra myometrial region may be helpful in complete removal. The placement of the optical and secondary ports determines the degree of ergonomic surgery performance, time and difficulty of myoma enucleation, and the ease of suturing. reducing the bleeding during enucleation, dissection in the right plane, minimal use of cautery and proper suturing and closure avoiding any haematoma formation are key points for a successful myomectomy. Use of diluted vasopressin is very effective in making the surgery blood less. So also the use of bipolar in coagulating the large blood vessels. Using bipolar diathermy, a dissecting grasper, and a suction cannula, meticulous exploration of the dissection field can more efficiently detect and coagulate any actively bleeding vessels. Slow rotation of the bevelled morcellator and good control of the bag could reduce de novo myoma and endometriosis. The surgery outcome and the risk of intraoperative complications are highly dependent on trocar placement, finding of the correct cleavage plane, haemostasis, and suturing technique. Flap technique is an innovative approach for removing small fibroid near junctional zone. Good surgery with respect to minimal destruction and handling of the healthy tissue, avoiding unnecessary organ manipulation, controlled bleeding, minimal coagulation, and reasonable operating time remain the best ways to diminish the risk of adhesion formation.It is very important to preserve the cavity, minimal adhesion formation and perfect suturing avoiding dead spaces and haematoma formation for a successful out come in infertile patient.

Лапароскопічна одночасна дивертикулоектомія сечового міхура та уретероцистостомія за Lich-Gregoir

To show the advantages of laparoscopic technique as a method for the best visualization and simplification of the method of surgical intervention in diverticulum of bladder, and the technique of antireflux surgery for vesicoureteral reflux of different degrees in children. Purpose - to share experiences and demonstrate the technique of making the antireflux mechanism, and to show life hacks to make the bladder diverticulectomy easier. Materials and methods. In 2016-2021 there were 23 patients with VUR of different degrees. Two of them had a bladder diverticulum. In one case - ectopia of the ureter into the diverticulum. In another case the ingress of the ureter was anatomically correct. Results. Steps of operation. The patient’s position is on the back with a roller under the lumbar region. The optical port is installed transumbilically. Two working ports are installed: on the middle line between the navel and the «spina illiaca anterior» of pelvic. Pneumoperitoneum - 8-10 mm Hg. Technique. At the same time with laparoscopy, cystoscopy to better visualize of edge of the diverticulum. After that, the diverticulum was excised and the walls of the bladder were sutured. In the case of ectopia of the ureter into the diverticulum made ureterocystomy, followed by antireflux protection by Lich-Gregoir. And in another case only antireflux protection was made. Specificity of antireflux protection technique. Marking and forming of the submucosal tunnel does by a hook and / or scissors. Previously do the traction of the bladder over the ureter in the direction of the anterior abdominal wall. The next step is to fix the bladder with three holders, which are output. This makes it easier to dissect the layers of the bladder. The ureter was placement into the sub mucous tunnel. And muscular tunica and walls were sutured of material 4/0. Specific of drainage. When antireflux protection perform - the stent was not installed into the ureter. At ureterocystoneostomy - the stent was placements for a period of 30 days. Drainage of abdominal was performed in all cases. An urinary catheter was additionally placements in the bladder for 3 days. There were no intraoperative or postoperative complications. Duration of surgery up to 180 minutes. Conclusions. Laparoscopic ureterocystoneostomy is, in our opinion, more convenient for the surgeon and more gentle for the patient. Allows you to significantly reduce the number of postoperative complications. This laparoscopic diverticulectomy of the bladder has been demonstrated, showing a significant advantage in the convenience of visualization of the diverticulum and easier removal of the diverticulum of the bladder. The study was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of parents and children was obtained for the study. No conflict of interests was declared by the authors. Key words: diverticulum of bladder, laparoscopy, ureterocystostomy.