METHOD FOR DETERMINATION OF OPTIMAL SURGICAL ACCESS TO VERMIFORM APPENDIX DURING VIDEO-ASSISTED APPENDECTOMY THROUGH UNIFIED LAPAROSCOPIC ACCESS

摘要

FIELD: medicine.;SUBSTANCE: when choosing the optimal access for laparoscopic appendectomy, a pre-operative evaluation of linear and angular parameters on the sagittal image obtained with spiral computed tomography of the abdominal cavity is performed. In the sagittal plane cut, thickness of the anterior abdominal wall belly in two points: 1 point - at the navel level, 2 point - 3 cm above the pubic symphysis. Localization of the vermiform appendix is determined. Through each of the two points on the anterior abdominal wall, cuts are made in a cross-axial plane including point 1 and the vermiform appendix base, and a cross-axial plane including point 2 and the vermiform appendix base. Two vectors are plotted from the vermiform appendix base to each point, lengths and angles of the vectors to the horizontal plane of the vermiform appendix base are measured, after which the access point is selected. If the vector length is less than the instrument operating length, and the angle of vector inclination is from 45 to 90 degrees, a point with a smaller thickness of the anterior abdominal wall is selected. If the thickness of the abdominal wall at points 1 and 2 is the same, then a point with a shorter vector length is selected. In case of the same abdominal wall thickness and the same length of vectors, a point with a larger value of the vector inclination angle is selected.;EFFECT: method allows to perform a preoperative assessment of parameters of laparoscopic access to the vermiform appendix in patients with contraindications to MRI, reduce the traumatism of a single laparoscopic access to the vermiform appendix due to an objective evaluation of the access parameters.;2 dwg, 2 ex