Patent RU-2664175-C1 (RU)
Inventor: Biktimirov Rafael Gabbasovich
IPC: A61B17/00
Filed: 2017-02-28
Granted: 2018-08-15
Abstract: FIELD: medicine.SUBSTANCE: invention relates to surgery and may be useful for laparoscopic bilateral nephrectomy in autosomal dominant polycystic kidney disease. Periomphalicaly 10 mm optical trocar, as well as 10 mm instrumental trocars in the left ileal region and epigastrium on the left, as well as a 5 mm trocar in the lumbar region to the left. Access is made to the left kidney, during which the peritoneum is opened through the avascular zone – the Told lines with mobilization of the left curvature of the colon, the medial descending part of the colon is extracted and displaced. Isolate the anterior surface of the left kidney within the paranephric fascia, visualize and secrete the renal vein, clip its inflows – the central vein of the left adrenal and gonadal vein. Isolate the aorta in the zone of her anastomosis with the renal artery. Isolate the renal artery, clip with two clips with a lock and intersect with an indent from the proximal clip for 2–3 mm. Isolate and clamp the left renal vein with three clips with a lock, two of which are imposed on the proximal end of the vein and one – on the removed renal end. Dissect the renal vein between the clips with the preservation of the stump 2–3 mm with an indentation from the clips remaining on the vein. Isolate with the use of bipolar coagulation left kidney from surrounding tissues with preservation of the left adrenal gland. Clamp and dissect the left ureter in its upper third for further use in reconstructive interventions. Aspirate the fluid contents of the left kidney cysts with a decrease in its volume. Operating zone is irrigated with an aqueous solution of iodine followed by aspiration. Visualization and allocation of the aortic anterior surface to the level of the superior mesenteric artery and the medial surface of the aorta to the level of the right renal artery in the aortic-caval gap is performed. Isolate and clip with two clips with a lock the right renal artery with turning off the blood flow in the right kidney. Remove the left trocars with preservation of the trocar in the left epigastric region for liver retraction. Transfer the patient to the position on the left side. Set on the right is a paraumbilical 10 mm optical trocar, as well as 10 mm instrumental trocars in the right ileal region and epigastrium on the right, as well as a 5 mm trocar in the lumbar region to the right. Access to the right kidney with displacement of the ascending section and right bend of the colon with exposure of the anterior surface of the right kidney. Perform the mobilization and displacement of the duodenum by the method of Kocher with exposure of the anterior surface of the inferior vena cava and the zone of its anastomosis with the renal vein. Clone the gonadal vein at the level of confluence in the vena cava with two clips and dissect the gonadal vein between the clips. Isolate the right renal vein, clip it with three clips with a lock and dissect the same way as clipping and dissecting the left renal vein. Renal artery is dissected without additional hemostasis. Allocate the right kidney. Place the macro preparations in plastic containers and alternately remove it through a previously made incision in the suprapubic region 10 cm long along Pfannenstiel. Remove all trocars and perform layer-wise suturing all wounds without draining the abdominal cavity.EFFECT: method allows to reduce the risk of infection of tissues, to reduce the volume of operational blood loss.1 cl