METHOD FOR SURGICAL MANAGEMENT OF PATIENTS WITH COMBINED RENAL, ADRENAL AND GALLBLADDER PATHOLOGY Russian patent published in 2020 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery and urology, and can be used for surgical management of patients with a combined renal, adrenal and gallbladder pathology. Method involves creation of a retroperitoneal working cavity, for which a bulletin dissection is performed, under control of a laparoscope three working ports are installed: by posterior axillary line below edge 12 of rib, along middle axillary line 2 cm above comb of ilium, along anterior axillary line at same level. Retroperitoneal endoscopic intervention is performed on the kidney or adrenal gland, and the kidney, adrenal gland or parts thereof are placed in a polyethylene container for further extraction to the outside. In the same patient's position on the operating table and the installed working ports, on the side of the retroperitoneal working cavity under the control of the laparoscope, a parietal peritoneum is exposed near the anterior wall of abdomen for 15 cm. Laparoscope and working tools are advanced through the produced peritoneal opening into the abdominal cavity, the gallbladder is visualized, tissue dissection is performed in the area of the Kalo triangle, clipping and intersection of the cystic duct and cystic artery. Gallbladder is mobilized from a bed and placed in the same polyethylene container, which is removed in nephrectomy through a supernumerary incision of skin, subcutaneous fat, an external sheet of aponeurosis and straight abdominal muscles, with kidney resection or adrenalectomy - through the expanded aperture of the port along the back-axillary line. In surgical intervention on left kidney or adrenal gland for performing simultaneous cholecystectomy after parietal peritoneal dissection and performing laparoscope and working tools in abdominal cavity, in area of umbilicus additional working port is installed.

EFFECT: method provides higher surgical efficiency ensured by performing cholecystectomy after the main stage of the operation without changing the patient's body position on the operating table and performing additional incisions for working ports.

1 cl, 1 ex