METHOD OF OPERATIVE ACCESS TO ENTIRE DESCENDING AORTA Russian patent published in 2012 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be applied for operative access to entire descending aorta. Skin is dissected on lower edge of left greater pectoral muscle from the level of III rib to left edge of breastbone in VI intercostal space. Formed skin flap and left greater pectoral muscle are mobilised medially. Ends of II-VII ribs are separated from left edge of breastbone body and access into anterior mediastenum is performed. Anterior rib-mediastenum fold of parietal pleura is dissected and pleural cavity is opened. Internal pectorial vessels are ligated and dissected and thoracotomy is performed on III intercostal space to left posterior axillary line. Ends of intercoastal wound are brought apart by means of spreader. Left phrenic nerve is mobilised from the side of pleural cavity. Diaphragmatic portion of pericardium is separated from diaphragm. Cut of covering tissues is extended from left edge of breastbone down on medial edge of rectus abdominis and is stopped 5 cm from inguinal ligament. Anterior wall of rectus abdominis sheath is dissected. Muscle is brought outwards. Laparotomy is performed through central part of posterior wall of sheath. Parietal peritoneum is dissected on left lateral canal from the side of abdominal cavity. Retroperitoneal cellular tissue with descending part of colon, left kidney, pancreas is separated from posterior abdominal wall, brought to the right, turning around vascular pedicles. Entire abdominal aorta is exposed. Pericardial part of diaphragm is dissected from the angle of sternocostal triangle to aortal lumen, exposing part of descending part of pectoral aorta through cut of diaphragm.

EFFECT: method makes it possible to reduce trauma of chestbone, muscular and neurovascular structures.

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