OBJECTIVE
The aim of the study was to standardize caudocranial access for laparoscopic right-sided hemicolectomy.
MATERIAL AND METHODS
In the period from May 2022 to June 2023, on the basis of the Department of Endoscopic Surgery of the N.D. Yushchuk National Research Institute of the Russian University of Medicine of the Ministry of Health of the Russian Federation, manipulation angles were measured in 21 patients during surgical intervention of laparoscopic right-sided hemicolectomy using caudocranial access at 3 remote points: the dome of the cecum, hepatic bend colon, the lower horizontal part of the duodenum with a standard arrangement of laparoscopic ports. After analyzing the obtained measurements of the manipulation angles and searching for a correlation between the parameters, an optimal spatial model of the trocar arrangement is proposed. Using the optimal trocar location model, 18 patients were operated on from June 2023 to March 2024, and manipulation angles were studied at the same 3 remote points as with the standard model.
RESULTS
The median manipulation of the angle in the standard location of the trocar during laparoscopic right hemicolectomy when measured at the dome of the cecum was 63° (range 13—180°), on the hepatic flexure of the colon median was 43° (range 24—114°), the lower horizontal part of the duodenum — 57° (range 30—141°). Taking into account the revealed optimal range between trocars in the right and left iliac region — 15.5—21 cm, the height of patients, the standardized value of the manipulation angles is from 45 to 75°, an optimal spatial model of the location of trocars is proposed. This model includes the following access points: a 10 mm optical trocar is installed under the navel (in the mesogastric region from below); a 5 mm port in the right iliac region is installed 2 cm medial to the spina iliaca anterior superior of the right iliac bone and 2 cm below the linea bispinalis; Then a 12 mm working port is installed at the identified optimal range of 15.5—21 cm from the 5 mm working port in the direction of the left iliac region and 2 cm above the linea bispinalis; the 4th working 5 mm trocar is installed in the left hypochondrium 15 cm above the working 12 mm trocar. When using the optimal model of the location of the trocar median manipulation of the angle when measured at the dome of the cecum was 82° (range 69—93°), on the hepatic flexure of the colon median was 50° (range 40—71°), the lower horizontal part of the duodenum — 71° (range 43—90°). It is worth noting that when using this model of trocar arrangement during laparoscopic right-sided hemicolectomy, the difference in the range of values at all three measured points is from 24° to 47°, compared with the standard trocar arrangement — from 90° to 167°.
CONCLUSION
Thus, the optimal spatial model of the trocar arrangement for the use of caudocranial access during laparoscopic right-sided hemicolectomy was experimentally substantiated.
