METHOD OF LAPAROSCOPIC RADICAL LEFT-SIDED NEPHRECTOMY WITH THROMBECTOMY FROM THE INFERIOR VENA CAVA Russian patent published in 2023 - IPC A61B17/94 

FIELD: medicine; urology; oncology.

SUBSTANCE: invention can be used for the treatment of renal cell cancer complicated by tumor thrombosis of the inferior vena cava of the first level. The patient is placed in a supine position. Laparoscopic access to the left kidney and its mobilization is performed transmesenterically, dissecting the ligament of Treitz, peritoneum and mesocolon tissue by 3–4 cm and forming an oval opening in the mesentery of the descending colon. The left renal artery is clipped, then the left renal vein affected by the tumor thrombus is isolated to the point of its entry into the inferior vena cava (IVC). The ileocolic artery is dissected from surrounding tissues. The mesentery of the small intestine is dissected to the level of the duodenum above the IVC with the formation of an oval window in the mesentery of the small intestine. A braid is inserted through the trocar hole, passed through the previously formed holes in the mesentery of the large and small intestines, and the mesentery of the small intestine is suspended from the anterior abdominal wall. The IVC is dissected from the surrounding tissues, the renal vein is dissected at the site of its confluence with the IVC, and the tumor thrombus is removed. The left kidney with the tumor thrombus is removed en bloc through the previously formed foramen ovale in the mesentery of the descending colon.

EFFECT: method allows to completely eliminate the stage of mobilization of the descending colon, dissection of the colon-splenic and spleno-diaphragmatic ligaments when accessing the left kidney, thereby minimizing the risks of damage to the wall of the colon and spleen; allows adequate access to the inferior vena cava without extensive mobilization of the ascending colon, which eliminates the risk of liver injury and significantly reduces the likelihood of postoperative adhesive disease, acute intestinal obstruction, and intussusception.

1 cl, 2 ex