METHOD OF PREOPERATIVE MODELING OF LAPAROSCOPIC ACCESS DURING KIDNEY SURGERY Russian patent published in 2023 - IPC A61B17/00 G09B23/28 A61B17/34 A61B6/02 

FIELD: medicine; surgery; urology.

SUBSTANCE: on the obtained axial section, the zone of operational interest, which is the center of the kidney tumor is determined. A rectangular triangle ABC is built on this section, where A is the projection point of the zone of operational interest on the anterior abdominal wall, B is the zone of operational interest, BC is the leg of a right triangle with an angle of C=60°. The resulting hypotenuse AC corresponds to the depth of the wound and is the plane of the surgical action located at an angle of 60° to a horizontal surface. In the native phase, a plane of operational interest is determined, which is a line connecting the center of the tumor and the orifice of the right renal artery for the right kidney, and the orifice of the left renal artery for the left kidney. The thickness of the subcutaneous fat at the level of the navel is determined. The projection points of the tumor center onto the anterior abdominal wall and the projections of the mouth of the vessel onto the anterior abdominal wall are determined on the 3D model. The installation point of the optical trocar is determined in the paraumbilical zone with an offset from the umbilicus towards the zone of operational interest by the thickness of the subcutaneous adipose tissue, so that the installation vector of the optical trocar is directed to the zone of operational interest. The installation points of manipulation trocars are determined so that the angle between the instruments is 90° according to the principle of triangulation, while to determine the locations of the calculated points of installation of the optical and working trocars, a coordinate system consisting of vertical anatomical lines on the anterior abdominal wall of the patient and horizontal anatomical lines is used.

EFFECT: method makes it possible to determine optimal trocar placement points at the preoperative stage when planning kidney operations using helical computed tomography data, depending on the scope of the intended operation and the anatomical features of the operated organ, and to quickly optimize access if necessary.

1 cl, 11 dwg, 1 ex