METHOD FOR SURGICAL ACCESS AT LAPAROSCOPIC SPLENECTOMY

FIELD: medicine, endovideosurgery. ^ SUBSTANCE: the present innovation deals with laparoscopic splenectomy out of lateral access. It is necessary to carry out US survey of spleen followed by its topography. At the entrance to abdominal cavity one should apply, at least, four trocar points to introduce through them optic and working instruments. The second point is on the middle line being 3-4 cm below xiphoid process, the third point is on the left posterior axillary line between the edge of left costal arch and iliac ala. Depending upon the sizes and location of spleen it is necessary to shift the first and the fourth trocar points to obtain the angles of surgical action between the axes of instruments ranged 45-90 at "attack" angle against the main splenic vessels being near 90. The first trocar point should be shifted downwards along the median clavicular line or along the mentioned line and to the right towards the body middle line or behind it. The fourth point together with a working instrument should be shifted downwards along the left anterior axillary line or downwards along the mentioned line and towards the line of the body middle line. The innovation enables to fulfill laparoscopic splenectomy in case of splenomegaly up to 30 cm along the organ's log by providing, thus, the safety of interference due to matching the angles between the instruments and in relation to splenic vessels being optimal for manipulations and, also, due to choosing the sites for locating trocar points depending upon splenic size and topography. ^ EFFECT: higher efficiency. ^ 2 dwg