Evaluation of the parameters of laparoscopic approaches using spiral computed tomography

The parameters of a single incision laparoscopic surgery (SILS) to the base of the vermiform process, the neck of the gallbladder and the duodenal bulb were assessed using spiral computed tomography (CT) in 101 patients and in an anatomical study on 98 unfixed corpses. Four median approaches and access in the left iliac region to the base of the vermiform process, umbilical and epigastric accesses to the neck of the gall bladder, the vertical subcostal, left subcostal and umbilical accesses to the duodenal bulb were evaluated. According to the CT and anatomical data, it has been established that the umbilical access to the appendix provides the optimal conditions for performing surgical interventions using the SILS - technology. In addition, access “2” by individual criteria has the most advantageous spatial characteristics and can also be used for minimally invasive access to the appendix. When comparing the umbilical and epigastric accesses to the neck of the gallbladder, it was found that the epigastric approach is appropriate for the introduction of a manipulation trocar, the umbilical approach is for extracting the gallbladder and visualizing it in minimally invasive surgery. According to the CT and anatomical studies, it was found that the vertical subcostal access to the duodenal bulb has the characteristics sufficient to perform surgical interventions using a SILS - technology.