METHOD FOR PERFORMING RADICAL ROBOTIC-ASSISTED PROSTATECTOMY WITH TEMPORARY CROSS-CLAMPING OF INTERNAL ILIAC ARTERIES Russian patent published in 2024 - IPC A61B17/00 A61B34/30 A61M25/10 

FIELD: medicine; surgery; urology.

SUBSTANCE: patient is laid on his/her back in Trendelenburg position. 20 Ch urethral Foley catheter is inserted. Laparocentesis is performed in an upper paraumbilical point, through which an optical trocar is inserted, and a carboxyperitoneum is performed. Thereafter, three working trocars of the da Vinci robot and an assistant port are inserted laterally to the left and to the right of the median line. Thereafter, the peritoneum is opened, the anterior wall of the parietal peritoneum is opened below the navel, and the pre-bladder space is approached. Ventral surface of the prostate and bladder is separated. Then, the prostate is dissected from the bladder neck, followed by the separation of the posterior surface of the prostate, seminal vesicles and deferent ducts, wherein the deferent ducts are crossed, the seed vesicles are released completely. Further, the prostate is separated from the surrounding tissues along its own capsule from the posterior and lateral surfaces with preserving Denonvilliers' fascia. Then the vascular pedicles of the prostate are clipped and transected at the base. That is followed by further dissection of the lateral surfaces of the prostate, followed by an apical dissection. Then the prostate is cut off from the urethra and immersed in a laparoscopic evacuator. Then a bladder-urethral anastomosis is formed using an absorbable suture material with a continuous suture on a Foley catheter, and the urethral catheter is replaced with a similar one. Further, tightness of the anastomosis is controlled by introducing normal saline through the catheter into the bladder. Further, a drainage tube is inserted into a small pelvis to a zone of a bladder-urethral anastomosis through a contraincision, and carbon dioxide is desufflated from the abdominal cavity. Preparation, namely a prostate with lymphatic tissue, is removed through a wound from a trocar, in which an endoscope is located, extending a longitudinal incision from one of the ports in layers to the abdominal cavity. Thereafter, interrupted skin wounds are sutured. Operation is carried out using a robot-assisted technology using a da Vinci robot, under endotracheal anesthesia, peritoneum is opened above common and external iliac vessels, after which ureters are identified, lymph node dissection is performed from the level of aortic bifurcation, presacral zone of common, external and internal iliac vessels, as well as obturator pits on the right and on the left. When separating the ventral surface of the prostate and bladder, the intrapelvic fascia is opened and the puboprostatic ligaments are transected, and internal iliac arteries are subjected to bulldog vascular clamps. Dissection of the lateral surfaces of the prostate is performed without preserving the neurovascular bundles. In addition, after hemostasis of the bed of the removed prostate, a posterior reconstruction of the pelvic floor is performed, and then the vascular clamps are removed, wherein Foley catheter 20 Ch is used for the anastomosis, wherein 150 ml of normal saline is introduced into the bladder, and after the saline administration, the bladder neck is anteriorly fixed to the remains of the puboprostatic ligaments and the dorsal venous complex.

EFFECT: method enables reducing the amount of blood loss and the length of the surgical intervention.

1 cl, 1 ex