METHOD FOR CREATING RETROPERITONEOSCOPIC APPROACH WHEN PERFORMING HEMINEPHRECTOMY AND RESECTION IN HORSESHOE KIDNEY Russian patent published in 2024 - IPC A61B17/94 

FIELD: medicine.

SUBSTANCE: invention relates to video endoscopic urology. Trocars are inserted into the retroperitoneal space. With the patient lying on his side, 2 cm incision is made along a middle axillary line. Retroperitoneal space is found with the index finger and a working space is created. 10 mm trocar is inserted and closed tightly. 10 mm trocar is introduced under the control of the optics along the posterior axillary line, and the optics is transferred into this port. Then 5 mm trocar is placed along an anterior axillary line, and a psoas muscle and Gerota fascia are exposed with mobilization of a posterior surface of the kidney. Then, the table is tilted 30 degrees to the left towards the patient’s abdomen—when performing the operation on the right or to the right—when performing the operation on the left, further, a vascular pedicle is mobilized along the posterior surface, and the involved half of the kidney and ureter are mobilized step-by-step. Renal isthmus is exposed, and vessels entering it from the aorta and inferior vena cava are mobilized. Optics from posterior axillary line is moved into trocar of middle axillary line, table is leveled, and the table is tilted at 30 degrees towards the patient's back—to the left or to the right depending on which side the patient is lying on; a lower segment of the kidney is mobilized. Ureter and pelvis, isthmus and vessels in front and behind are mobilized from the front. Optics is moved into the trocar of the posterior axillary line, the table is leveled and tilted forward by 30 degrees, thereafter, the ureter is mobilized, ligated and transected, the proximal portion of the ureter is moved laterally under the vessels, and the vessels entering it from behind are lifted, clipped and transected. Vessels that interfere with the dissection of the isthmus, vascular clamps are applied on the vessels of the isthmus, the isthmus is dissected, an affected half of the kidney is mobilized and removed from the created along the middle axillary line of the mini-approach. Then the optics is moved into the trocar of the posterior axillary line, the table is leveled and tilted forward by 30 degrees, the vessels supplying the involved half of the kidney are lifted, they are clamped with a vascular clamp, the renal parenchyma is resected, the parenchyma wound is closed, the vascular clamp is removed from the pedicle; macropreparation is removed by wound dilation of 10 mm of trocar along posterior axillary line.

EFFECT: method makes it possible to perform heminephrectomy or resection of kidney due to fast approach to vessels from behind, their clipping and crossing or their temporary clamping during resection, which makes it possible to carry out further stages of operation almost without blood, and technical simplification of stages of kidney mobilization.

1 cl, 2 ex