METHOD OF EXTRAPERITONEOSCOPIC ADENOMECTOMY OF PROSTATE OF MORE THAN 80 cm Russian patent published in 2018 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to surgery and can be used for extraperitoneoscopic adenomectomy of the prostate of more than 80 cm³. 2 cm incision of skin, subcutaneous tissue and aponeurosis is performed below the umbilical ring along the median line, in which a cavity is formed by a forefinger in the preperitoneal space in the direction of the pubic articulation, formation of the cavity is completed using a balloon-dissector. After the balloon-dissector is removed into the formed cavity, a 10 mm optical trocar is installed in the pre-peritoneal space. Z-shaped suture is applied on the incision of aponeurosis and tighten. Through the installed 10 mm optical trocar in the preperitoneal space, carbon dioxide is supplied at a pressure of 12–14 mm Hg and an endoscope with a video camera is introduced, providing control over the course of surgical intervention, the image from which is displayed on monitors. Without damaging the lower epigastric vessels, the 10 mm trocar is placed on the left side of the midclavicular line 2–4 cm below the installed 10 mm optical trocar, and an ultrasound dissector is placed therein. Three 5 mm instrumental trocars are additionally installed with the possibility of installing a laparoscopic clamp in the upper trocar, aspirator – in the lower trocar. Anterior surface of the prostate is mobilized from fat using the ultrasound dissector. 5–7 cm incision of the prostate capsule is performed in the middle part of the prostate in the transverse direction with simultaneous ultrasound coagulation of small vessels and bipolar coagulation of large vessels. Along the length of the incision of the capsules, a space is formed between the capsule of the prostate and the adenoma nodes with vessel coagulation and visualization of the surgery field using the aspirator. Consistent enucleation of adenomatous nodes is performed from the base, lateral surfaces and top of the capsule of the prostate from its right and left sides with coagulation of the prostatic arteries and smaller vessels and with traction of nodes with a laparoscopic clamp alternately to the right, left, up and down in the base of the prostate and the neck of urinary bladder. Prostatic section of the urethra is removed with the monopolar coagulation of the adenoma bed with a bulbous electrode in the "spray" mode. Posterior semicircle of the neck of bladder is hemmed to the lower semicircle of the urethra with trigonisation of the prostate bed. Incision of the capsule of the prostate is sewn by an intracorporeal suture. Preperitoneal space is drained. Enucleated nodes of prostate adenoma are placed in an endoscopic plastic container, which is further removed after removal of the optical trocar through an expanded paraumbilical incision.

EFFECT: method allows reducing blood loss, preserving the muscular framework and vascular-neural bundles of the anteriolateral abdominal surface, ensuring guaranteed removal of tissue of large volumes.

1 cl, 3 ex