Patent RU-2694219-C1 (RU)
Title: Method for fascia- and nerve-sparing robot-assisted radical prostatectomy
Inventor: RAPOPORT LEONID MOISEEVICH
IPC: A61B17/00
Filed: 2018-10-22
Granted: 2019-07-09
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, namely to oncology and urology. Foley catheter is placed into urinary bladder, catheter balloon is inflated, operative field is prepared for laparoscopy. It is followed by incision of the para-ulbicular region, peritoneal incision is performed, Trocar No. 12 Ch is introduced into the abdominal cavity for the optical telescope, carboxyperitoneum is created, additional trocar 8 mm and trocar 12 mm are inserted along a single line below the first trocar. Robotic system and installed trocars are combined. Robotic instruments are inserted into the abdominal cavity; an anterior semi-circle is used to dissect the parietal peritoneum covering the pelvic organs from one deferent duct to the other one. Anterior bladder surface, a parietal endoplevical fascia of the pelvis, a visceral pelvic fascia covering the prostate, a bladder neck, pubourethral and pobevesical ligaments are mobilized. Borders between a bladder neck and a prostate are defined, without preliminary dissection of an endoplevical fascia of a pelvis are performed dissection punovevesical ligaments directly in a neck area of a bladder, then the anterior surface of the bladder neck is dissected with the visualization of the Foley catheter, the Foley catheter is removed through the incision of the anterior wall of the bladder neck, is fixed to an anterior abdominal wall, under the control of ureter orients, bases of the prostate gland are dissected lateral and posterior walls of the bladder neck to form an anastomotic surface. Prostate, seminal vesicle and deferent duct bases are separated; prostate traction is performed anteriorly, with its removal from the rectum. Interfascial mobilization is carried out, sequential mobilization of the prostate is carried out, removing it from the surrounding fascias, starting from its posterior surface with subsequent mobilization of the posterior surface of the prostate, separation of prostate gland from neurovascular bundles adjoining the gland on the side of its posterolateral surfaces. Vascular elements extending from the neurovascular bundles to the prostate are coagulated in sparing modes or clipped by a small amount of ML size clips. Method comprises sequential mobilization of side surfaces, displacement of vascular and facial elements from prostate surface with mobilization of posterior surface of rectourethral muscle and urethra, prosthesis grasper is cranially tapped with a visceral pelvic fascia incising the anterior prostate surface maximally cranially, preserving the peveviscal ligament elements and the main component of the dorsal venous complex actively participating in the urine retention mechanisms and containing a portion of the erectile nerves. Prostate gland is mobilized and fixed solely on the urethra and the underlying rectourethral muscle. Urethra is transected as close as possible to the apex of the prostate with the intersection of the rectourethral muscle. Prostate veculomy is performed, a Rocc suture is sutured V-loc2-3/0, reinforcing back support of the urethra, an anastomosis is formed with a continuous suture with a V-loc thread with two 3/0 needles, and a Foley catheter is inserted into the bladder. Tightness of the anastomosis is verified, paubovezical ligaments and visceral pelvic facies, previously dissected earlier, are dissected earlier, providing for anterior support of the urethra. Small pelvis is drained through incision and trocars are successively removed. Prostate is removed together with the seminal vesicles and elements of the deferent ducts through the extended parabubilical incision; the wound layers are layer-by-layer wounded with application of an aseptic sticker. 
     EFFECT: method allows preserving the support and ligamentous apparatus of the male small pelvis, as well as elements of peveausical ligaments and the main component of the dorsal venous complex taking active part in the urine retention mechanisms and containing part of the erectile nerves. 
     1 cl, 1 ex