METHOD FOR LAPAROSCOPIC TREATMENT OF EXTENDED OBLITERATIONS OF THE UPPER THIRD OF THE URETER AND URETEROPELVIC JUNCTION Russian patent published in 2021 - IPC A61B17/94 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to urology. The method of laparoscopic treatment of extended obliterations of the upper third of the ureter and the ureteropelvic junction includes the removal of the cicatricial-stenotic part of the ureter and the ureteropelvic junction and plasty with a buccal autograft. In this case, laparoscopic dissection of the affected part of the ureter and the region of the pelvic-ureteric segment with the surrounding tissue is performed along the proximal border of obliteration. The affected section of the upper third of the ureter is mobilized together with the affected tissue to healthy tissues, the ureter is removed outward through the trocar opening, and the altered area is cut off. The ureter is spatulated along the anteromedial surface with a length of 1 cm, a pre-prepared buccal graft, the length of which is determined by the length of the detected defect + 1 cm, is fixed along the entire proximal edge of the ureter with a continuous suture with monocryl 4/0. An internal drainage stent # 6 Ch is installed and the buccal graft is sutured over the stent with a continuous external suture of 4/0 monocril, not reaching 1.5 cm to its distal edge. A 4/0 monocril thread is applied to the free edge of the buccal graft and a knot is tied, the buccal graft with the ureter is immersed through the trocar opening into the abdominal cavity, through the re-installed laparoscopic port, it is fixed to the posterior edge of the pelvis with a pre-applied 4/0 monocril thread with a continuous suture throughout the posterior the edges of the anastomosis, form the anterior surface of the pelvis anastomosis with a buccal graft with a continuous 4/0 monocril suture. Then the buccal graft is fixed with single sutures monocril 4/0 on the ventral surface of the psoas muscle. An omentum flap is cut out on the feeding stem with a width corresponding to the length of the buccal graft, brought to the anastomosis and positioned without tension over the entire surface of the buccal graft and the place of its implantation. The omentum flap is fixed with single 4/0 monocryl sutures along the edges of the buccal graft with grasping of the ureter tissue and single 4/0 monocril sutures directly to the buccal graft itself.

EFFECT: method allows to reduce the invasiveness of the intervention by performing part of the operation extraperitoneally without additional incisions, to reduce the number of relapses and to achieve a stable therapeutic effect for more than 2 years; to reduce the time of surgical intervention against the background of an increase in its volume due to extracorporeal formation of a neoureter, placement of a stent and the imposition of an additional thread on the buccal graft for its further fixation to the pelvic tissue; to reduce the number of postoperative complications in patients with obliteration of the upper third of the ureter and the pelvic-ureteric segment after previously unsuccessful surgical interventions on the ureters; to ensure reliable vascularization of the buccal graft, which is carried out in two directions - fixation of the neoureter to the psoas muscle, which provides improved vascularization of the neoureter due to muscle tissue and fixation of the omentum flap without tension to the buccal graft at several points; ensure complete tightness of the anastomosis.

1 cl, 1 ex