SURGICAL APPROACH CHOICE METHOD Russian patent published in 2009 - IPC A61B17/94 A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, laparoscopic surgery. Inserted instrument position is simulated while detecting the angles included in-between. Magnetic resonance scanning ensures constructing the frontal, saggital and axial projections representing the inner object structure. The 3D object picture is reconstructed while visualising the body surface topography anatomic landmarks with using VGStudio MAX 1.0 software by Volume Graphics GmbH. The prospective insertion points x₁, x₂, x₃ are located and marked on tomograms and the patient body. Thereafter the angles are made of the vertexes and vectors corresponding to the instrument axes: the angle α between the telescope axis and the auxiliary instrument axis, the angle β between the telescope axis and the prime instrument axis, the angle γ between the auxiliary instrument and the prime instrument axes. The angle vertexes are positioned in a point "А" related to the vascular fascicle and end points of operation region on a target organ "Б" and "В" on all the orthogonal projections. Vectors are positioned in turn on the prospective insertion points x₁, x₂, x₃. It is followed with making a bisector of angle γ starting from the point "А" to the body surface in the point x₁. Made angles and vector length between the points "А", "Б", "В" and the body surface are measured. Provided three conditions of laparoscopic operations: instrument axes angle is more than 25° and less than 90°, vector passes through the organ-free space, vector length is less than flute length, thus choosing laparoscopic approach. Provided: instrument axes angle is less than 25° and more than 90°, vector passage through anatomic barriers, vector length exceeds flute length, vectors are to be displaced with changing the angles so that vectors passes through the organ-free space, instrument axes angles are more than 25° and less than 90°. There are located new working points "Г", "Д", "Е". It is followed with control positioning of the angle vertexes on the end points of the region. Vectors are positioned in turn on new working points "Г" and "Е" with making a bisector of angle γ started from the point "А" to the "Д" on the body surface. Vector lengths and angles are measured observing all the three conditions of laparoscopic operation to choose laparoscopic approach. If the three conditions of laparoscopic operation are failed to be observed, laparotomy is preferred. Method is simple, anatomically reasonable, does not required considerable time consumption and material cost.

EFFECT: optimal arrangement of laparoscopic instruments for each patient, cutting operative time, lower rate of perioperative complications and conversions.

6 dwg, 1 ex