LAPAROSCOPIC RETROPUBIC ADENOMECTOMY SUPPLEMENTED BY URETHROCYSTOANASTOMOSIS Russian patent published in 2022 - IPC A61B17/94 A61M25/04 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, to operative urology. Endovideoscopic access is performed, optical and working trocars are installed in the retropubic space, carboxyperitoneum is created under general anesthesia, laparoscopy is performed - examination of the abdominal cavity. Adenomectomy is performed, the surface of the prostate gland is isolated, the capsule of the prostate gland is dissected in the transverse direction, and hemostasis is controlled. A layer is isolated between the capsule and adenomatous tissue of the right and left lobes of the prostate gland, adenomatous nodes are cut off from the urethra and placed in a container. In addition, the middle lobe of the prostate is removed, hemostasis control and vascular coagulation are carried out. The tissues of the bladder neck are compared with the urethra, the prostate gland capsule is sutured with a V-lock thread, then the container is removed. In this case, the specified adenomectomy is supplemented with stages of urethrocystoanastomosis. Laparoscopic access is performed, while 3 working trocars are installed pararectally in the right and left iliac regions. The anterior and lateral surfaces of the prostate are mobilized to the intrapelvic fascia after dissection of the prostate capsule and identification of the layer between the adenomotous nodes of the right and left lobes of the capsule and its inner surface. The nodes are isolated as a single block, the bladder neck is displaced with a predominance of blunt dissection. The bleeding vessels are coagulated. Then urethrocystoanastomosis is performed: after identifying the bladder neck, an anastomosis is performed with two V-lock 3/0 threads between the urethra and the bladder neck with a continuous suture, starting from the back wall, from 6 o'clock of the conventional dial, in opposite directions, until crossing on the anterior surface of the anastomosis at 12 o'clock of the conditional dial. After that, an N20 Foley urethral catheter is installed, 150 ml of saline is injected into the bladder, the prostate capsule is sutured with a continuous suture with a V-lock 3/0 thread, wound revision, hemostasis. The container with macropreparations is removed through supraumbilical access.

EFFECT: method provides accelerated recovery of the mucosa of the prostatic urethra and, accordingly, the best functional result of treatment, significantly reduces the volume of postoperative blood loss, while the hospital stay is reduced to 4 days, as a result, the quality of life of patients is improved.

1 cl, 6 dwg, 1 ex