Method for left partial nephrectomy
SUBSTANCE: peritoneum and mesocolon tissues of a descending colon are incised above an involved region and above a vascular renal pedicle to perform a left partial nephrectomy. Through the local mesocolon incision above the vessels, a renal artery is filopressed and compressed for thermal ischemia. A new growth is incised and evacuated through the mesocolon incision made above the involved region of the kidney.
EFFECT: method provides the ergonomic approach through a minimum thickness of the mesocolon tissues, minimises the risk of intestinal and splenic injuries and development of complications, ensures the fast postoperative intestinal functional recovery.
2 cl, 2 ex
The invention relates to medicine and can be used in urology.
The most effective treatment of renal cell carcinoma is operational, and organ-preserving intervention is considered a priority [the Summary of recommendations of the European Association of urology / edited by M. Kogan. - Rostov-on-don: OOO "omega-Print", 2009. - 317 p.]. Evolution of laparoscopic technologies in urology has led to the almost total abandonment of traditional interventions in localized tumors of the kidney. So, laparoscopic partial nephrectomy recognized by the European Association of urology the method of choice in the treatment of renal cell carcinoma in stages Τ1[Clinical guidelines of the European Association of urology / Resp. edited by T. V. Lukovkin, N. In. Chernozhukov, A. G. Shegai. - M.: OOO "ABC-press", 2010. - 1031 p.].
Algorithm traditional laparoscopic partial nephrectomy provides a broad mobilization of the colon with the intersection of the colon-splenic and splenic-phrenic ligament to expose the retroperitoneal space and the vascular pedicle of the kidney. The kidney is excreted in the fascia of Gerota so widely, as needed, to expose the tumor. Then dissected adipose capsule of the kidney to the healthy parenchyma. The allocation of the renal artery during W is carried out after�ROCA mobilization of the colon. Only after that carry out temporary clamping for the formation of thermal ischemia. On the background of the last tumor excised within healthy tissue, and the integrity of the anatomical structures is restored seam [Puchkov K. V. Laparoscopic surgery for kidney cancer / K. V. Puchkov, A. A. Krapivin, V. B. Filimonov. - M.: publishing house "medical practice-M, 2008. - S. 123-139 (the prototype of the present invention) Stolzenburg J-U. Laparoscopic and robot-assisted surgery in urology. Atlas of standard procedures / J-U. Stolzenburg, LA. Turk, E. N. Liatsikos. - Springer Heidelberg Dordrecht London New York, 2011. - 79-85].
The stage of mobilization of the colon and secretion of the renal artery is at least one third of operational time and is accompanied by some risk of iatrogenic intraoperative complications, such as injury of the bowel wall and damage to the spleen arising from the mobilization of the descending part of the colon in 1% and 1.2% respectively [Popov S. V. computer assisted surgery in the treatment of patients with renal tumors / S. V. Popov, A. I. Novikov, O. N. Skryabin, D. V. Zaitsev. - SPb.: Maps, 2011. - 224 p.].
This has been a cause of the development of an alternative method transtentorial partial nephrectomy without mobilization of the descending colon.
The problem solved in the present invention is to develop a method of partial nephrectomy to minimize the risk of complications
Achievable technical results due to the implementation of the developed method are:
- ergonomic access to the surgical area of interest (the area of the kidney, the tumor) using a minimum thickness of tissue of the mesocolon, without resorting to broad mobilization of the colon with the intersection of the colon-splenic and splenic-phrenic ligament. This minimizes the risk of injury of the intestine and spleen, and therefore, eliminates the complications associated with these lesions;
- optimization of the operation caused, including by reducing the duration of the operation, because it eliminates the need for the mobilization of the colon that? in addition to reducing the risk of complications, leads to the most rapid recovery of bowel function in the postoperative period.
The method is as follows.
Local dissection of the peritoneum and tissues of the mesocolon of the descending colon just above the vascular pedicle of the kidney, in the direction of the vessels, and over the tumor area of the kidney, thereby forming a "window" to access the affected area of the kidney. Optimal is making a cut so that the length of the defect in the mesocolon exceeded tumor diameter not less than 25%. Through a local incision mesocolon over the vessel�and is a limited selection of the main or segmental renal artery, which is fixed in the turnstile for subsequent transient clamping to ensure total or segmental thermal ischemia, respectively. Excised tumor cold shears within the healthy tissue together with fatty tissue, and covered her. A remote part of the kidney with tumor evacuated through a "window" mesocolon into the abdominal cavity, and then out. The wound of the kidney sutured in layers, and then sutured the window in the mesocolon.
Clinical example No. 1
Patient F., aged 65, was hospitalized with complaints of recurrent back pain on the left. When examined in the clinic, ultrasound data, revealed a tumor of the left kidney. According to the control CT revealed a tumor of the lower segment of the left kidney up to 3 cm, located on the border of lower and middle thirds of the anterior surface of the left kidney; the pathology of regional lymph nodes were found. Clinical diagnosis defined as "Cancer of the left kidney c T1N0M0". In this connection, we carried out laparoscopic transtentorial partial nephrectomy.
The technique of operation. The position of the patient on the back". Through a puncture in umbilically region is a trocar with laparoscope. During the audit the abdominal cavity revealed no pathology. The patient was transferred to the operating table in the Trendelenburg position (10°) and the "healthy" side (30°). Working trocars installed� in the epigastrium and along the lateral edge of the rectus abdominis. On the border of lower and middle third of the posterior-lateral surface of the projection of the left kidney, through the mesocolon, visualized a tumor, protruding above the surface of the kidney. Through the mesocolon, visualized renal vein. Along the course of the last made a linear incision of the peritoneum and tissues mesocolon with denudation of the vascular pedicle of the kidney. Renal artery locally allocated, fixed in the turnstile. Linear mesocolon dissection of tissue over the tumor, accessed fascia Gerota. On the background of thermal ischemia, which lasted 15 minutes, the tumor is excised with cold scissors within the healthy tissue together with fatty tissue, and covered her. The integrity of the anatomical structures of the kidney restored intracorporeal suture. Upon restoration of renal blood flow produced by the control of hemostasis. The surgery area drained through a separate puncture in the lumbar region. The drug is evacuated from the abdominal cavity in the plastic container. "Window in the mesocolon sutured. Deathplace. Suture wounds. The operation lasts for 75 minutes. Blood loss volume of 70 ml.
The postoperative period without complications. The patient became active on the day of surgery. After 8 hours was the first after the surgery chair. Conducted prevention of thromboembolic and infectious complications, the differential treatment. Need to�narcotic analgesics, and blood transfusion was not. In a satisfactory condition the patient was discharged under the supervision of a urologist clinics on the fourth day after the operation. At the control examination after a year of feeling satisfied patient, works, leads his normal life. According to the control MSCT data for the progression of the disease there. Blood tests and urine without pathology.
Clinical observation No. 2.
Patient I., aged 45, was hospitalized at the urology center of the Gorky railway without complaint. With ultrasound during a routine medical examination revealed a tumor of the left kidney. According to the control MRI with contrast defined tumor of the anterior surface of the lower segment of the left kidney to 3.7 cm Clinical diagnosis defined as "Cancer of the left kidney c T1N0M0". In this connection, we carried out laparoscopic transtentorial partial nephrectomy.
The technique of operation. The position of the patient on the back". Through a puncture in umbilically region is a trocar with laparoscope. During the audit the abdominal cavity revealed no pathology. The patient was transferred to the operating table in the Trendelenburg position (10°) and the "healthy" side (30°). Working trocars are installed in the epigastrium and along the lateral edge of the rectus abdominis. On the border of lower and middle third on the anterior surface of the projection of the left kidney, through the mesocolon, thick�that tumor formation, protruding above the surface of the kidney. Through the mesocolon visualized renal vein. Along the course of the last made a linear incision of the peritoneum and tissues mesocolon with denudation of the vascular pedicle of the kidney. Selected segmental renal artery, pityusa the lower pole of the left kidney. Artery is fixed in the turnstile. Linear mesocolon dissection of tissue over the tumor accessed fascia Gerota. On the background of segmental thermal ischemia, which lasted 10 min, the tumor is excised with cold scissors within the healthy tissue together with fatty tissue, and covered her. The integrity of the anatomical structures of the kidney restored intracorporeal suture. Upon restoration of renal blood flow produced by the control of hemostasis. The surgery area drained through the trocar wound in the iliac region. The tumor was evacuated from the abdominal cavity in the plastic container. "Window in the mesocolon was usualis. Deathplace. Suture wounds. The operation lasts for 80 min. Volume of blood loss of 40 ml.
The postoperative period was uneventful. The patient became active on the day of surgery. After 10 h after the operation was the first independent chair. Narcotic analgesics, and blood transfusion was not used. On the fifth day after the operation the patient was discharged to outpatient stage of treatment. Six months later, produced by the audit inspection: �alob no, feeling pleased to be working at the same place, leads a normal life. According to the MRI control area operations without pathology, no signs of progression. Clinical blood and urine without pathology.
1. A method for performing partial nephrectomy on the left, including the implementation of the access to the left kidney, excision of the tumor, the restoration of the anatomical integrity of the structures, characterized in that the access to the affected area of the kidney are performed by local dissection of the peritoneum and tissues of the mesocolon of the descending colon over the affected area of the kidneys and over the vascular pedicle of the kidney, then through a local incision mesocolon over the vessels that carry a limited selection of the main or segmental renal artery, which is fixed in the turnstile for subsequent transient clamping, thereby achieving total or segmental thermal ischemia, respectively, excised the tumor within healthy tissue together with fatty tissue, it covered, in a remote part of the kidney with tumor evacuated through the slit in the mesocolon is made over the affected area of the kidneys in the abdominal cavity, and then out, the wound of the kidney is sutured in layers.
2. A method for performing partial nephrectomy on the left according to claim 1, characterized in that the optimal size of the cut tissue of the mesocolon is�the looks of the incision is greater than the diameter of the tumor by at least 25%.
SUBSTANCE: planned skin incision is first configured on an anteriolateral neck surface by projection zoning of a clavisternomastoid and a neck median line to be marked with colour graphic lines. A first line extends along a medial border of the clavisternomastoid. A second line extends from a suprasternal notch to the middle of a hyoid shaft. Both of the lines are then combined by drawing a perpendicular third line from a lower border of the middle of a hyoid shaft to the medial border of the clavisternomastoid, thereby forming a projection triangle. Cutaneofascial layers, platysma and subcutaneous fat are incised along the first and third lines to cut out a musculocutaneous flap, which is brought outwards. Underlying soft tissues are dissected to an anterior surface of cervical spinal bodies by splitting subcutaneous fat between a neurovascular bundle and a pharynx, detaching an intracervical fascia, splitting perioesophageal subcutaneous fat and displacing midline organs of the neck in the medial direction, and the neurovascular bundle - in the lateral direction.
EFFECT: method enables reducing a risk of treatment-induced traumatic injuries of the midline organs of the neck, an upper laryngeal nerve, upper and lower thyroid arteries, as well as a parenchyma and an excretory duct of a submandibular salivary gland with optimising topographo-anatomical relations of the incision wound structures, thus providing a surgical angle approaching 90 degrees.
SUBSTANCE: muscle of the neophallus is mobilised. A corset is formed intra-operatively according to the diameter and length of a mobilised muscle from a mesh with non-absorbable polypropylene 0.5-0.6 mm thick monofilaments, with the porosity of 85-90%, with run-proof edges in case of resection. The muscle is circularly wrapped up with the formed corset.
EFFECT: provision of the sufficient rigidity of the neophallus and elimination of its deformation due to the application of the corset, formed from the mesh with non-absorbable polypropylene monofilaments.
SUBSTANCE: invention relates to medical equipment, namely to sealing device for reparation of heart defect and vessel diseases in the process of performing surgical operations for treating such diseases as patent foramen ovale (PFO) or heart stunt, vascular system diseases, etc. Sealing device contain stretchable frame ad sealing element. Frame contains multitude of wires, each of which passes from proximal end to distal end of frame. First and second segments from multitude of wires form wound proximal loop and distal loop respectively. Multitude of wires form proximal disc and distal disc when sealing devise is extended. Proximal disc and distal disc are located between proximal and distal loops. Each wire from multitude of wires forms respective petal of proximal disc and respective petal of distal disc. Respective petals form zones of overlapping and unsupported sections. Sealing element, at least, partially encapsulates extending wire frame.
EFFECT: invention has improved compatibility with heart anatomy, it is easier to extend, reposition and return into initial condition in the place of opening.
25 cl, 16 dwg
SUBSTANCE: invention refers to medicine, namely surgery, and can be used for treating aseptic pancreonecrosis. Intra-organic pulseless pancreatic segments are localised and removed. To cover the pancreas, a greater omentum is incised into two portions - 1/3 from the left and 2/3 from the right up to a base of the greater omentum. Segments with pulse oscillation amplitude not less than 3.0 mm in the left 1/3 of the greater omentum and not less than 2.0 mm in the right 2/3 of the greater omentum are localised. The left portion in the distal segment is anchored with U-sutures to peripancreatic subcutaneous fat, whereas the right portion in the distal segment is anchored to a right hepatic lobe.
EFFECT: method enables arresting the disease progression and preventing infected pancreatic necrosis, improving pancreatic tissue blood supply by detecting the intra-organic pulse, removing all necrotic portions of the pancreas and using the greater omentum to cover the pancreas.
3 dwg, 2 ex
SUBSTANCE: distal pancreas resection is performed. That involves transecting a parenchyma to the right from a superior mesenteric vein. That is followed by a resection of an anterior surface of the pseudocysts of the head of pancreas. A Roux pancreatocystojejunoanastomosis with isolated enteric loop is created.
EFFECT: reduced intraoperative injuries and risk of postoperative complications, lower extent of the operation, preserved portion of the pancreatic parenchyma and physiological passage of food and bile in the gastrointestinal tract by the distal pancreas resection and created pancreatocystojejunoanastomosis with the cyst walls and the anterior surface of the head of pancreas.
SUBSTANCE: invention refers to systems for applying a filling material onto a working surface and can be used for applying a multicomponent compound, such as a surgical filling material for a tissue mass. A mixture feed device comprises a Luer mandrel sub-assembly, a cannula and a nozzle atomiser sub-assembly. The Luer mandrel sub-assembly is formed to contact at least two containers and forms the first and second fluid pipes of the mandrel for facilitating the flow of the first and second components. The cannula comprises the first and second cavities carrying the fluid. Each cavity is fluid connected to one of the first or second fluid pipes of the mandrel. The nozzle atomiser sub-assembly is arranged at the end of the cannula and involves at least a part of a nozzle insert placed into a nozzle cap. The nozzle cap has an end wall with an outlet therein. The nozzle insert and nozzle cap form at least three feed channels and are configured to limit at least three fluid passages in three respective feed channels. Each of the three feed channels is fluid connected to the fluid passage.
EFFECT: more effective mixing of the components, prevented cross-contamination of the components and facilitated fluid feed.
12 cl, 25 dwg
SUBSTANCE: invention refers to traumatology and orthopaedics and is applicable for joint drainage in revision endoprosthesis replacement. A drain tube is inserted into a wound with implanting a bone cement spacer containing an antibiotic. Within the first 24-48 postoperative hours, the fluid content is actively gradually evacuated from the postoperative wound every hour for 10-15 minutes.
EFFECT: method enables increasing the antibacterial effect.
SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, and can be used in myringoplasty, for repairing partially lost anatomic structures, such as tympanic membrane. The surgery is performed with local or general anaesthesia. A tympanic membrane defect is closed with a thinned prepared alloplant in the form of an allogeneic cartilage plate. Before implanting, the alloplant is fragmented up to 0.2-0.3 mm thick and 0.8-0.9 cm in diameter that is followed by placing the plate into a bottle with a fixing fluid. The final stage of the operation involves placing the alloplant on the edges of the tympanic membrane defect. The cartilage plate is supposed to be more by 1.0-1.5 mm in size with the plate edges to be ovelapped with the acoustic meatus skin. The acoustic meatus is packed.
EFFECT: method provides the reliable fixation of the alloplant, preventing its postoperative dislocation and retraction, audiological characteristics of the alloplant as close to the characteristics of the normal tympanic membrane as possible, the absence of implant rejection and pronounced immune response, proteolytic enzyme stability, necessary rigidity of the cartilage plate, reduced length of the intervention, the absence of a cosmetic auricle defect.
SUBSTANCE: surgical management of colon cancer is required in low colonic obstruction. A midline laparotomy and abdominal organs inspection is followed by colon mobilisation. A colonic segment with a tumour is resected. The segmented intestine is decompressed with an electric suction machine. The rectal stump is stitched with a stapling apparatus. A superposed segment of the segmented intestine is mobilised to be brought down. A tunnel is formed behind the rectal stump from the side of the anus as close as possible to the oral end of the stump. A hole is formed along the posterior wall with an electric knife and used to bring down the mobilised segmented intestine by means of a guide. The intestine is fixed to the hole borders with four stitches. The excessive intestine is brought out through the anus and fixed to the perineal skin. A dioxidine solution is administered into the abdominal cavity. The rectal stump is daily washed with antiseptic solutions until the excessive brought out intestine is dissected away on the 10-14th day.
EFFECT: method enables applying the primary stitch-free colorectal anastomosis, requires no rehabilitation stage of treating colon cancer by the natural formation of the anastomosis and prevention of its leakage; it also reduces the length of disability and improves the patient's quality of life.
1 ex, 2 dwg
SUBSTANCE: axial line of two enclosing incisions is marked by connecting the centres of outer mouths of fistula sequentially from up to down by a wavy line. That is followed by making two wavy enclosing incisions parallel with the axis: right and left at 20 mm from the axial line. The left incision starts 15 mm above the proximal outer mouth of fistula, and ends 15 mm below the distal outer mouth of fistula, whereas the right incision starts at the level of the proximal outer mouth of fistula and ends at the level of the distal outer mouth of fistula. Thereafter, RPF is excised in the radial direction. Two L-sutures relaxation incisions are made. The upper relaxation incision originates from the point at the beginning of the right enclosing incision and extended to the point at the beginning of the left enclosing incision and 20 mm further, turned at a right angle 25 mm upwards, and an upper triangular adipocutaneous flap is formed. The lower relaxation incision originates from the point at the end of the left enclosing incision and extended to the point at the end of the right enclosing incision and 20 mm further, turned at a right angle 25 mm downwards, and a lower triangular adipocutaneous flap is formed. That is followed by closing a wound defect by adipocutaneous repair by shifting the formed upper and lower triangular adipocutaneous flaps onto the wound defect and fixing them with interrupted sutures. The lower edge of the upper adipocutaneous flap is fixed to the right enclosing incision, and its upper edge - to the left enclosing incision. The lower edge of the lower adipocutaneous flap is fixed to the left enclosing incision, and its upper edge - to the right enclosing incision; thereafter, the wavy s are closed.
EFFECT: more effective surgical management of recurrent pilonidal fistulas, reduced number of complications and recurrences and improved aesthetic effect of the operation.
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg
SUBSTANCE: method involves carrying out left-side laparophrenotomy. Esophagus and stomach stump extirpation is carried out. Large intestine is conducted in the posterior mediastinum. Distal end-to-end anastomosis of transplant and the duodenum is created using atraumatic sutures.
EFFECT: enhanced effectiveness of plastic repair in the cases of resected stomach cancer.
SUBSTANCE: method involves carrying out hernia removal in intralaminar way. Posterior longitudinal ligament defect is covered with Tacho-Comb plate after having done disk cavity curettage. Subcutaneous fat fragment on feeding pedicle is brought to dorsal surface of radix and dural sac.
EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.
FIELD: medical engineering.
SUBSTANCE: device has thread knitted into fabric. Fabric for tamponing wound and removing it by pulling the thread is connected to internal film surface with collagen gel. The film overlaps fabric area and has opening equal to two-lumen draining tube canal connected to external film surface and having one canal longer than the other one. Distal end of the shorter canal is connected to opening in the film and distal end of the longer one is brought outside of its boundary. Proximal ends are connectable to vacuum receiver. Fabric thread is brought to the shorter canal from the internal wall and fixed on the external shorter canal wall.
EFFECT: reliability in stopping hemorrhages and retaining patient mobility.
SUBSTANCE: method involves applying sling urethropexy. Pneumoextraperitoneum is created by means of trocar introduced under the pubis. Then, longitudinal perineotomy and paraurethral tissue dissection is carried out to the right and to the left towards the descending branches of pubic bones to pelvic fascia. The urethra is moved to its left. TVT needle is introduced under descending branch of pubic bone to the right of the urethra. The pelvic fascia is perforated in away that needle tip enters retropubic space laterally with respect to the prostate and in front of the urinary bladder. The needle is brought along the posterior pubic bone surface and exits via abdominal wall outside pulling one end of polypropylene ribbon. The like manipulations are accomplished at the left side to form a loop around the urethra tightly adjacent to bulbocavernous muscles. Final ribbon fixation is carried out after having eliminated the pneumoextraperitoneum and having removed the trocar.
EFFECT: simplified operation; avoided intra- and postoperative complications and recidivation.
SUBSTANCE: method involves evaginating duodenum stump with polypotomy loop into organ wall followed by electric surgical excision.
EFFECT: stable hemostasis; provided aseptic conditions in sealing the stump.
3 dwg 1 tbl
SUBSTANCE: method involves carrying out rein performing pancreaticoduodenal resection. Cholecystoenteroanastomosis is built. Anastomosis application takes place between the right hepatic duct and gallbladder neck near its flexure.
EFFECT: prevented biliary hypertension.
FIELD: medicine, surgery.
SUBSTANCE: one should perform incisions of parietal peritoneum by leaving 2 cm against inferior and superior edges of patient's pancreas being of 1.5 cm length to apply them in checkered order for the purpose to prevent vascular lesion.
EFFECT: higher efficiency of decompression.
FIELD: medicine, surgery.
SUBSTANCE: the method is applied for the purpose to correct combined deformations of external nose due to oral-vestibular operative access. The method deals with dissecting mucosal membrane and periosteum in oral vestibule followed by separating soft tissues of the upper lip. Then one should perform internal incision along the edge of alar cartilages to connect two incisions together. Then comes final tissue separation at subsequent correction of the shape, size of external nose structures and its septum. The method enables to achieve wide access to all the structures of external nose and provide optimal cosmetic result.
EFFECT: higher efficiency of correction.
FIELD: medicine, urology.
SUBSTANCE: the present innovation deals with affecting the sclera and applying deformation-correcting sutures at the background of medicinal erection. Along lateral surfaces of cavernous bodies symmetrically from both sides one should make incisions of scleral surface layer. Then comes manual derotation, moreover, at the side of derotation incision's lower edge should be shifted downwards and backwards, its upper edge - upwards and to the front, and at contralateral side the lower edge is shifted downwards and to the front, and the upper edge - upwards and backwards. After manual penile derotation one should apply sutures onto the edges of dissected scleral layer in incision area by shifting needle's puncture out towards the side being opposite to shift direction of the lower edge against incision's perpendicular axis. The quantity of incisions should be calculated by the following formula: Q = N/n, where Q - the desired quantity of incisions, N - the angle of total initial rotation, n - the angle of derotation achieved after applying sutures onto the first pair of incisions. The method enables to decrease the risk for development of either new or residual penile deformation in postoperational period.
EFFECT: higher efficiency of correction.
3 dwg, 1 ex