LAPAROSCOPIC RETROPUBIC ADENOMECTOMY SUPPLEMENTED WITH TEMPORARY CLAMPING OF THE INTERNAL ILIAC ARTERIES Russian patent published in 2022 - IPC A61B17/00 A61B17/94 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, to operative urology. An endovideoscopic access is performed, optical and working trocars are installed in the retropubic space. Under general anesthesia create carboxyperitoneum. Laparoscopy is performed - examination of the abdominal cavity. The blood vessels of the pelvic region are isolated, clamps are applied to the vessels, the surface of the prostate gland is isolated to the pelvic fascia, and adenomectomy is performed. The prostate capsule is dissected in the transverse direction. 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, vessels are coagulated, hemostasis is controlled, the bladder neck is trigonized in the region of its posterior wall and fixed to the urethra. The prostate capsule is sutured with a continuous suture with a V-lock thread, the vascular clamps are removed, and the container is removed. The indicated adenomectomy is supplemented with the stages of temporary clamping of the internal iliac arteries - VPA. Laparoscopic access is performed. At the same time, 3 working trocars are installed pararectally in the right and left iliac regions. The peritoneum is dissected in the projection of the bifurcation of the external iliac artery and the SIA on the right, in the area of the intersection of the common iliac artery and the ureter, the SIA is mobilized using energy tools, the SIA is taken on a silicone holder, hemostasis is performed in the work area. The peritoneum is dissected in the projection of the bifurcation of the external iliac artery and the SIA on the left, in the area of the intersection of the common iliac artery and the ureter, with the use of energy tools, the SMA is mobilized. VPA is taken on a silicone holder, hemostasis is performed in the work area, the anterior and lateral surfaces of the prostate gland are mobilized up to the intrapelvic fascia. Vascular clamps of the "Bulldog" type are applied to the right and left VPA in the area of bifurcations, after dissection of the prostate capsule and identification of the layer between the adenomatous 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. After cutting off adenomatous nodes from the urethra and placing them in a container with VPA, vascular clamps are removed, hemostasis of the bed of adenomatous nodes is monitored, bleeding vessels are coagulated, and the indicated trigonization is performed. The container with macropreparations is removed through supraumbilical access.

EFFECT: method allows to significantly reduce the volume of intraoperative blood loss, while the terms of hospitalization are reduced to 4-5 days, significantly increase the efficiency of the main stages of the operation and reduce their duration, as a result, improve the quality of life of patients.

1 cl, 5 dwg, 1 ex