METHOD OF TREATMENT OF ARTERIAL ISCHEMIA OF THE LOWER EXTREMITIES AT THE DISTAL BY TYPE OF LAPAROSCOPIC RETROPERITONEAL LUMBAR SYMPATHECTOMY Russian patent published in 2016 - IPC A61B17/94 

FIELD: medicine.

SUBSTANCE: triangulation retroperitoneal access in the form as close as possible to the sympathetic trunk, containing 2, 3 and 4 ganglion. To this end the initial access point is selected in the middle of the segment posterior axillary line, limited 12th rib and iliac crest. Points manipulators input is selected as a point located at a distance of 2-3 cm from the ends of the segment mid-axillary line, a limited margin of the 12th rib and the iliac crest. At the same time on the operating table, which includes headache, back and leg section, the patient is laid on its side with tilt back at an angle of 50-70° to the back section, placing a cushion under his lumbar region and lowering the head and foot section to achieve the greatest distance between the iliac crest of the patient and his 12th rib. Veress needle is introduced vertically downwards through the external and internal oblique and transverse abdominal muscles, carbon dioxide is injected in a volume of at least 1.5 l, preferably 1.5-2.0 l, maintaining the pressure of 12-15 mm Hg. Workspace form bounded above the peritoneum, preperitoneal fiber, ureter and, if the right of access, inferior vena cava, while the left access - infrarenal aorta, below the square loin muscle and psoas major muscle, from the sides, with access rights, the left kidney and perirenal fiber, the right iliac crest and the iliac muscle at the left access, on the sides - the left iliac crest and the iliac muscle, the right kidney and perirenal fiber.

EFFECT: method allows to increase the quality of care by reducing the morbidity and duration of surgery and improve the usability of it.

1 cl, 3 dwg, 1 ex