METHOD FOR CONDUCTING ENDOVIDEOSURGICAL ADENOMECTOMY WITH EXTRAPERITONEAL ACCESS USING A MORCELLATOR Russian patent published in 2021 - IPC A61B17/94 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to urology. After retropubic access to the prostate by introducing an optical trocar and two working trocars into the retropubic space and insufflation of carbon dioxide into the retropubic space, the anterior surface of the prostate is isolated, while the pelvic fascia is not opened. A transverse section of the anterior surface of the prostate capsule is made 1.5-2 cm below the proximal to the puboprostatic ligaments, 5-7 cm long, a layer is isolated between the capsule and the adenomatous tissue of the right and left lobes of the prostate. Then, bluntly and using the THUNDERBEAT apparatus, the adenomatous nodes are cut off. The prostatic urethra is cut off. Then small vessels are coagulated by bipolar coagulation, a trocar with a diameter of 10 mm is replaced by 12 mm, and an Olympus morcellator is brought to the adenomatous nodes. After removal of the adenomatous tissues, the posterior wall of the bladder with the urethra is fixed by 1 cm proximal to the vas deferens with a continuous V-Loc thread with a 5/8 needle 15 cm long, the posterior wall of the bladder is "trigonized" followed by a needle puncture on the anterior surface of the upper leaf of the capsule prostate gland. Next, suturing is performed along the right semicircle of the prostate capsule with the capture of the bladder wall along the lateral, with the transition to the anterior surface, symmetrically suturing the tissues on the left side. Control the tightness of the anastomosis; then the adenomatous tissue is immersed in the container and removed. A tubular drainage is installed in the retropubic space. Sutures are applied to the skin, iodine treatment and an aseptic bandage are applied.

EFFECT: method allows to reduce trauma with subsequent shortening of the rehabilitation period, to reduce the likelihood of postoperative sclerosis of the bladder neck, to preserve the muscular frame and to provide accelerated rehabilitation of the patient after surgery with a simultaneous increase in his quality of life.

1 cl, 4 dwg, 1 ex