METHOD OF SIMULTANEOUS TREATMENT OF BLADDER DIVERTICULA BY TRANSVESICAL METHOD IN COMBINATION WITH THULIUM LASER ENUCLEATION OF PROSTATE ADENOMA Russian patent published in 2023 - IPC A61B17/94 A61N5/67 A61B8/00 A61M25/01 A61K33/14 A61P43/00 

FIELD: medicine; surgical urology.

SUBSTANCE: US-guided puncture of bladder in the dome area is performed when the patient is lying on the surgery table on his back after insertion of urethral catheter and filling the bladder with solution of 0.9% sodium chloride and the subsequent insertion of trocar with 12 mm diameter for video laparoscope directly into the bladder. Then the bladder is emptied with urethral catheter and the latter is blocked. Insufflation of the bladder cavity is produced with CO₂ under a pressure of 12 mm Hg. The laparoscope is inserted into the bladder through 12 mm trocar, trocars and ports for operating instruments are placed in the bladder: one port with a diameter of 5 mm is inserted with scalpel through skin puncture 3 cm to the right of the main access guided with iliac bones position. The second port with a diameter of 11 mm is placed 5 cm to the left of the main access, guided with iliac bones position. Then circular lamellar dissection of the bladder is performed, departing from diverticulum neck 0.5 cm up to paravesical tissue. Then traction by the mobilized edge of diverticulum neck is performed, blunt and sharp dissection of paravesical tissue along the diverticulum wall is carried out until it is completely cut off. After that paravesical tissue is examined and hemostasis is performed. The walls of the diverticulum bed and the edges of the bladder mucosa are brought together by suturing with a v-loc 3-0 thread with a 5/8 needle bend. The excised tissue of the diverticulum is removed in a single block in a container through a 11 mm or 12 mm port, instruments, trocars are removed, sutures and an aseptic dressing are applied in layers on the skin, then, without removing the patient from anesthesia, they are transferred to the lithotomy position and the second stage of the surgical procedure is carried out, which is the ThuLEP procedure.

EFFECT: method allows to perform in full all stages of endovideosurgical transvesical diverticulectomy, completely eliminate obstruction at the level of the prostatic urethra, which improves urination parameters and prevents the development of recurrence of bladder diverticula; the method is maximally safe today due to the marginal reduction of surgical trauma and the time of surgical intervention.

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