Patent RU-2733698-C1 (RU)
Title: Method for extraperitoneal radical prostatectomy with use of epidural anaesthesia
Inventor: POPOV SERGEJ VALEREVICH
IPC: A61B17/00
Filed: 2019-07-09
Granted: 2020-10-06
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, namely to urology, and can be used for surgical management of prostate cancer. In patient's position lying on side or in sitting position, skin is treated in triple way with aqueous 70 % ethanol solution. Then under local anaesthesia 2.0 ml of 2 % lidocaine with Tuohy 20G needle at L1-Th12 level is punctured and catheterized epidural space, wherein catheter is performed in cranial direction by 3 cm. Puncture needle is removed, an aseptic sticker is applied with catheter fixation to skin of back, patient is placed on back and test dose 3.0 ml of 2.0 % solution of lidocaine is introduced. If blood pressure and heart rate is stable and 98–99 % blood saturation is used, 10.0 ml of 1.0 % ropivacaine solution is administered. In 15 minutes after development of sensory block to level Th8 and satisfactory motor unit for sedation by means of syringe pump, microfluid introduction of 1 % propofol in amount of 3–5 mg/kg*h is started. Thereafter, skin incision 2.0–2.5 cm long is made in periomphalic region 3 cm below the umbilicus, and a retropubic space is inserted in layers. Primary cavity is formed by means of the index finger. Working space is then formed in a retroperitoneal way by means of a manual bullet dilator, then a laparoscope is introduced into it. If the balloon dissector is properly positioned, it is removed and a laparoscope is inserted through the above access into the working cavity. Then trocars and ports are placed: two trocars with diameter equal to 5 mm, through scalpel skin punctures are installed on 3 cm to the right and to the left of the main access. Two ports, the diameter of the first of which is 12 mm, of the second one - 5 mm, are positioned on the iliac spines. Installation of the first twelve-millimetre port is performed at 3 cm median of right iliac bone through skin incision 1 cm long, installation of second five-millimeter port - similarly to the left. That is followed by sequential skeletonisation of an anterior prostate and bladder surface, alternate formation of two tunnels on the right and left of a projection of a bladder neck in a layer of adipose tissue located medial to a tendon pelvic arch and lateral to pubovesical complex, until deferent ducts and seminal vesicles appear. On the inner surface of the formed tunnels, the outer lateral bundles of the detrusor and the vesicle-prostatic muscle are verified and transected, thus freeing the proximal urethra along the posterolateral semicircle. Then, the tunnels are combined. Further, the prostate base contour is moved from the depth to outside from 6 to 12 o'clock of the conventional clock face; detrusor front apron is split cranially; intersecting the proximal portion of the intraprostatic urethra; seed complex is separated and seed ducts are transected. It is followed by posterior dissection of prostate; separating the layer between the lateral periprostatic, intramuscular fascia and the fascia of the muscles lifting the anus until the pubic peroneal muscle is exposed on both sides, orientated on the adipose tissue layer between the pubovesical complex and the front periprostatic fascia, they are separated to urethral sphincter. Dorsal venous complex is not pierced; distal urethra is separated and transected; prosthetic gland is moved into container for further extraction; anastomosis is applied between the proximal urethra and the bladder neck by continuous self-tightening sutures. Profiled urethral Foley 18Ch catheter is inserted. Cylinder is inflated to 10 ml and tightness of anastomosis is monitored by administering 150 ml of sterile physiologic saline. Prostate and seminal vesicles are removed by single unit in container through central port access. 
     EFFECT: method provides eliminating the development of negative consequences and maximum radicality when removing a tumour, an involved organ and regional lymph nodes by reducing the probability of perioperative complications of general anaesthesia and reducing trauma of the surgical intervention. 
     1 cl, 6 tbl, 1 ex