METHOD FOR REDUCED FASCIO- AND NERVE-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY Russian patent published in 2021 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely to the field of oncology. A Foley catheter is installed in the bladder. The balloon of the catheter is inflated. The operating field is treated, covered with sterile linen for laparoscopy, an incision is made in the paraumbilical region, the peritoneum is dissected, trocar No. 12 Ch for an optical telescope is inserted into the abdominal cavity, and carboxyperitoneum is created. 3 additional trocars of 8 mm and 1 trocar of 12 mm are installed 4 cm below the first trocar, the PatientCarta robotic system of the installed trocars is aligned. Robotic instruments are inserted into the abdominal cavity, the parietal peritoneum covering the pelvic organs from one vas deferens to another is dissected along the anterior semicircle, the anterior surface of the bladder, the parietal endopelvic fascia of the prostate gland, pubourethral and pubovesical ligaments are mobilized. The boundaries between the bladder neck and the prostate gland are determined, without preliminary dissection of the endopelvic fascia of the pelvis, the pubovesical ligaments are dissected, the walls of the bladder neck with visualization of the Foley catheter, the Foley catheter is removed through the incision of the anterior wall of the bladder neck, and it is fixed to the anterior abdominal wall. Under the control of the ureteral orifices, the base of the prostate gland, the lateral and posterior walls of the bladder neck are dissected with the formation of an anastomotic surface, after isolation of the base of the prostate gland, seminal vesicles, vas deferens, traction of the gland anteriorly, dilution of the Denonvillea fascia leaves, sequential mobilization of the prostate gland is performed. Moreover, the vascular elements coming from the neurovascular bundles to the prostate gland are clipped with double titanium medium-small clips for reusable 5 mm clippers. A semicircular incision of the anterior surface of the visceral prostatic fascia of the pelvis is made, directed by the cranial concavity, leaving on the base and body of the prostate the elements of the fascia itself, the puboprostatic ligaments and the fine-bore venous network, which are tightly adjacent to the organ, while preserving the same elements and the main array of the dorsal venous complex, which together make up the “veil of Aphrodite”, covering loosely only the apex of the prostate gland.

EFFECT: this is an “anatomical” and “nerve-sparing” method, since it allows to preserve the neurovascular bundles and the main body of the dorsal venous complex, as well as part of the “veil of Aphrodite”, which contain a part of the erectile nerves.

2 cl, 2 ex