METHOD OF PELVIC PARIETAL PERITONECTOMY DURING CYTOREDUCTIVE SURGICAL INTERVENTIONS IN PATIENTS WITH PERITONEAL CARCINOMATOSIS Russian patent published in 2023 - IPC A61B17/34 A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely surgery. Retractors are installed in the wound, the abdominal organs are inspected, the Karl STORZ Thermoflator 26432020-1 Insufflator is prepared, to which a 1.5 m long silicone tubing line is attached, and a puncture needle is attached to the line. With pneumodissection in the lateral direction, the peritoneum is punctured in the iliac fossa, at the level of the anterior superior iliac spine, retreating 1.5-2 cm from the edge of the laparotomy incision, the end of the needle is placed in the subperitoneal fascial layer, and 500 ml of gas is insufflated at the pressure of 30 mm Hg within 1.5 minutes. Then the needle is replaced with a flexible pathfinder, the gas pressure is kept in the range of 20-30 mm Hg. The flexible pathfinder is advanced parallel to the internal iliac vessels in the direction of the pelvic diaphragm, while the pathfinder entered should be 2-2.5 cm lateral to the right ureter. 15-20 mm from the bifurcation of the aorta in the caudal direction, the end of the needle is placed in the subperitoneal fascial layer, insufflated with 450 ml of gas at the pressure of 30 mm Hg within 1.4 minutes, the gas pressure should be 20-30 mm, then the flexible pathfinder is advanced along the common iliac vessels, thus connecting the posterior and lateral directions of pneumodissection. For pneumodissection of the pelvic peritoneum in the anterior direction, the peritoneum is punctured at a point located along the posterior surface of the rectus abdominis muscles at a distance of 2 cm above the pubic symphysis and 15-20 mm from the edge of the laparotomy incision, the end of the needle is placed in the subperitoneal fascial layer, and 300 ml of gas is insufflated at the pressure of 30 mm Hg within 1 minute. Then the needle is replaced with a flexible pathfinder and insufflation is resumed, while the pressure should be 20-30 mm Hg, with translational fan-shaped movements under visual control, the peritoneum covering the bladder is separated. After dissection of the peritoneum from the posterior wall of the bladder, the pathfinder is advanced in the direction of excavation vesicouterina in women, rectovesicalis in men. After performing tissue separation in the bladder area, the pathfinder is pulled towards itself, leaving 3-4 cm from the tip under the peritoneum. Next, a pneumodissection is performed 3-4 cm lateral to the bladder, the caudal border of the peritoneum mobilization in women is the vesico-uterine cavity, and in men - the vesico-rectal cavity, while a 18 G Seldinger needle is used as a puncture needle, which is inserted under the parietal peritoneum at the angle of 10-30° , and a flexible pathfinder is used with a size of 16 G.

EFFECT: method is easy to perform, is characterized by low injury rate, high safety and ablasticity, which creates conditions for the prevention of unintentional dissemination of tumour cells in the abdominal cavity and can be used when performing cytoreductive surgical interventions in patients with peritoneal carcinomatosis.

1 cl, 10 dwg