METHOD OF ENDOVIDEOSURGICAL ADENOMECTOMY USING EPIDURAL ANESTHESIA Russian patent published in 2020 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to urology, and can be used for surgical management of prostate adenoma. In the position of the patient lying on the right side, the skin of the back is treated by three times with aqueous 70 % ethanol, under local anesthesia with lidocaine 2.0 ml of 2 % solution of the Tuohy needle of 20G gauge at the level of L1-Th12 is punctured by 3 cm in the cranial direction and the epidural space is catheterized. Thereafter, the puncture needle is removed, an aseptic sticker is applied to fix the catheter to the skin of the back. Patient is placed on his back and a test dose of lidocaine 2.0 % – 3.0 ml is introduced. If the blood pressure and heart rate are stable and 98–99 % blood saturation, the main dose of Ropivacaine solution is 1.0 % – 10.0 ml. If, after 15 minutes, development of the sensory block to the level of Th10 and a satisfactory motor unit is noted, for the purpose of sedation with the Bbraun syringe pump, microfluid introduction of 1 % propofol is started at rate of 3–5 ml/kg⋅h. Then urinary bladder is catheterized by Foley catheter18; further along a middle line of abdomen, lateral to umbilical ring 2 cm-long incision is made, and a pre-bladder space is introduced in layers. Then, with the help of the index finger, the primary cavity is formed, into which the balloon dilator is inserted; a working space is formed in a retroperitoneally manner using a hand-held balloon dissector. Laparoscope is then introduced to evaluate the dilation stand correctness. Then, if the balloon dissector is properly positioned, the latter is removed and a laparoscope is inserted through the above access into the working cavity. Trocar with a diameter equal to 10 mm is then injected extraperitoneally to insufflate CO₂ up to 12 mm Hg. At 8 cm in lateral direction and on both sides under visual control there are two ports – on the left with diameter of 10 mm, on right – 5 mm; 2 port-trocar with diameter of 5 mm are installed on 3 cm more medially and above the latter. Pelvic fascia is opened on both sides of the prostate and side walls of the prostate are separated. Capsule of the operated organ is dissected closer to the bladder, a layer of the adenoma capsule of the right and left lobes of the prostate is separated. That is followed by fixing the posterior wall of the urethra to the bladder mucosa by a blunt method and using the THUNDERBEAT apparatus of adenomatous nodes. Prostatic capsule is sutured with continuous suture V-loc. Anastomosis tightness is monitored; then adenomatous tissue is immersed into container and removed, sutured to skin, iodine treatment and aseptic dressing application.

EFFECT: method provides a high level of safety and is easy to implement due to the epidural anesthesia and minimal surgical intervention.

1 cl, 6 tbl, 1 ex