METHOD FOR VIDEOLAPAROTRANSHIATAL ACCESS TO LOWER THIRD OF THORACIC ESOPHAGUS

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to surgery. Access is performed using video endoscopic equipment by puncturing abdominal cavity 10 mm with trocar 5–10 cm above the umbilical ring for installing a video laparoscope. Then immediately below the costal arch along the middle clavicular line on the left and on the right there are 10 mm – on left, and 5 mm – on the right – trocars. 5 mm trocars are placed from the xiphoid process and from the costal arch along the anterior axillary line to the left. Ultrasonic shears are used to dissect gastro-diaphragmatic and esophageal-diaphragmatic ligaments. That is followed by sagittal diaphragmotomy by A. G. Savinykh's technique; an additional functional instrument is installed through the laparoport in the epigastric region for blunt dissection or aspiration and irrigation of the operative field. After the esophagus is separated, a surgical approach is made; at the end, a diaphragm-cruroraphia is performed; sutures on the trocar wounds are applied.;EFFECT: method enables reducing injuries, reducing the risk of severe surgical and postoperative complications, improving visual control of the operation.;1 cl, 8 dwg, 1 ex