Preoperative calculation of angles of vision and working area in laparoscopic surgery to treat a giant hiatal hernia  

作　　者：Francisco Javier Perez Lara Rogelio Zubizarreta Jimenez Francisco Javier Moya Donoso Jose Manuel Hernández Gonzalez Tatiana Prieto-Puga Arjona Arturo del Rey Moreno Maria Pitarch Martinez 

机构地区：[1]Surgery Service,Antequera Hospital,Rincón de la Victoria 29730,Málaga,Spain [2]DOXA Microfluidics,Rincon de la Victoria 29738,Málaga,Spain

出　　处：《World Journal of Gastrointestinal Surgery》2021年第12期1638-1650,共13页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND Giant hiatal hernias still pose a major challenge to digestive surgeons,and their repair is sometimes a highly complex task.This is usually performed by laparoscopy,while the role of the thoracoscopic approach has yet to be clearly defined.AIM To preoperatively detect patients with a giant hiatal hernia in whom it would not be safe to perform laparoscopic surgery and who,therefore,would be candidates for a thoracoscopic approach.METHODS In the present study,using imaging test we preoperatively simulate the field of vision of the camera and the working area(instrumental access)that can be obtained in each patient when the laparoscopic approach is used.RESULTS From data obtained,we can calculate the access angles that will be obtained in a preoperative computerised axial tomography coronal section,according to the location of the trocar.We also provide the formula for performing the angle calculations If the trocars are placed in loss common situations,thus enabling us to determine the visibility and manoeuvrability for any position of the trocars.CONCLUSION The working area determines the cases in which we can operate safely and those in which certain areas of the hernia cannot be accessed,which is when the thoracoscopic approach would be safer.

关 键 词：Hiatal hernia ANGLES Approach LAPAROSCOPY THORACOSCOPY 

分 类 号：R655.4[医药卫生—外科学]