Method for left total nephrectomy
SUBSTANCE: left total nephrectomy is performed. A kidney is approached by forming an oval window into a mesocolon of a descending colon. The window area is limited by: v. mesenterica inf, arcus Riolani, a. colicae sin and a tail of pancreas. A ligament of Treitz, a peritoneum and mesocolon tissues are incised. A free oval area of the mesocolon and peritoneum are left on the kidney. The kidney is evacuated through the mesocolon window. The mesocolon is left open. A strand of a greater omentum is placed into a retroperitoneal cavity formed after the kidney has been removed. In specific case, the kidney is mobilised together with an adrenal gland.
EFFECT: method enables optimising the surgical procedure by eliminating the stage of intestinal mobilisation, leads to the fastest postoperative intestinal functional recovery.
3 cl, 2 ex
The invention relates to medicine and can be used in urology.
The most effective treatment for renal cell cancer remains operational. Evolution of laparoscopic technologies in urology has led to the almost total abandonment of traditional interventions in localized tumors of the kidney. So, laparoscopic nephrectomy recognized by the European Association of urology the method of choice in the treatment of renal cell carcinoma in stage T1-T2[The summary of recommendations of the European Association of urology. Edited by M. Kogan. - Rostov-on-don: OOO "omega-Print", 2009. - 317 C].
Any standard algorithm laparoscopic nephrectomy provides a broad mobilization of the colon with the intersection of the colon-splenic and splenic-phrenic ligament to expose the retroperitoneal space [Puchkov, K. V. Laparoscopic surgery for kidney cancer / K. V. Puchkov, A. A. Krapivin, V. B. Filimonov. - M.: publishing house "medical practice-M, 2008. - Pp. 94-111 (prototype developed method) 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. - 52-57].
This stage rarely takes less than a third operational time and is accompanied by some risk of iatrogenic intraoperative complications, such as wound wall �lshka and damage to the spleen, occur during 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 / C. B. 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 nephrectomy through a "window" in the mesocolon of the descending colon, without the mobilization of the last.
The problem solved in the present invention is to develop a method of total nephrectomy to minimize the risk of complications.
Achievable technical results are provided in the implementation of the developed method are:
- ergonomic access to the surgical area of interest 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 injuries.
- 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 fu�functions of the intestine in the postoperative period.
- developed access provides fast identification and secure precise dissection of the great vessels. The latter due to the minimal thickness of the tissue of the mesocolon, covering the vascular pedicle of the kidney, where Vienna Shine through the mesentery of the colon.
- used anatomical landmarks forming an oval "window" guarantee optimal extraction of the kidney within the fascia Gerota through this doorway. Creating a window of smaller size will not allow to evacuate through him a kidney. The formation of a wider "window" is impractical and fraught with risk of injury of the left colon vessels or the inferior mesenteric vein.
- leave mesocolon on the kidney, eliminates the risk of damage to the fascia Gerota and bleeding from underlying blood vessels.
The method is as follows.
Carry out the dissection of the ligament of Treitz, peritoneum and tissues mesocolon widely to form an oval "window" in the mesocolon of the descending colon, the top of which is limited by v. mesenterica inf, arcus Riolani, a. colicae sin and tail of the pancreas, and received a free oval part of the mesocolon and peritoneum leave on the kidney.
Using the generated access is made to the allocation of the abdominal aorta, renal and adrenal vessels (artery� and veins).
Produces a wide selection of the artery and vein of the kidney during. In accordance with the requirements of the first stage ablation ligated (legasuite/cleroidea) and intersects the renal artery at the site of its confluence with the abdominal aorta. Then ligated (legasuite/cleroidea) and renal vein intersects together with its tributaries (adrenal, gonadal, and lumbar veins). After the treatment of renal vascular organ megascale emit from all sides without compromising the integrity of the fascia Gerota and adipose capsule, complete with the adrenal or without. After mobilization of the ureter to the level of the common iliac vessels of his tie (be ligated/ kopiruyut) and cross. The body is evacuated through a "window" mesocolon into the abdominal cavity, and then out. The window in the mesocolon not sutured. In formed after removal of the kidney cavity in the retroperitoneal space is placed a strand of greater omentum.
Clinical example No. 1.
Patient X., 38 years. Hospitalized with complaints of recurrent back pain on the left. Outpatient ultrasound examination revealed a tumor of the left kidney. MRI - a solid education to 7 cm is located on the border of lower and middle third of the posterior-lateral surface of the left kidney with the signs of infestation pelvis; data for pathology of lymph node not�. On the survey results, the clinical diagnosis was verified as "Cancer of the left kidney cT1N0M0"in this connection we carried out laparoscopic transtentorial nephrectomy.
The technique of operation. The position of the patient on the back". Optical trocar in umbilically area. After inspection of the abdomen 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. Formed transtentorial access to the left kidney. Why cut the ligament of Treitz, the peritoneum and tissues mesocolon widely to form an oval "window" of the mesentery of the descending colon, the top of which is limited by v. mesenterica inf, arcus Riolani, a. colicae sin and tail of the pancreas. Part of the mesocolon and of the peritoneum on the left kidney. Using the generated access selected the mouth of the left renal artery, which is the hour be ligated the abdominal aorta and the cross. Then Legerova and crossed renal vein tributaries. Megascale, the left kidney was mobilized within the fascia Gerota whole, without adrenal gland. The ureter is mobilized to the level of the iliac vessels, where Legerova and crossed. The drug is extracted through a window in the mesocolon and evacuated from the abdominal cavity in the plastic container. Through a "window" in the mesentery of Obodo�Oh bed of excised intestine kidneys are filled with the lock of the greater omentum. Deathplace. Suture wounds.
The operation lasts for 55 minutes. The volume of blood loss of 50 ml.
The postoperative period is smooth. The patient became active in the first day. At the same time marked the restoration of bowel function (stool within 12 hours after surgery). Need narcotic analgesics, and blood transfusion was not. In a satisfactory condition the patient was discharged under the supervision of a urologist clinic on the fifth day after surgery. At the control examination after a month of being patient is good, works at the same place, leads a normal lifestyle. According to the control ultrasound surgery area of pathology. The blood and urine tests within normal limits.
Clinical example No. 2.
Patient L., 72 years of age. Hospitalized at the urology center of the Gorky railway with complaints of recurrent nagging pain in your lower back on the left and increased blood pressure up to 190/110 mm Hg ultrasound examination revealed a tumor of the upper pole of the left kidney up to 7 cm According to the control MSCT with contrast, heterogeneous verified tumor of the upper pole of the left kidney up to 6.5 cm in maximum dimension, densely adjoining to the adrenal gland. Education is uneven contrast; of signs of involvement of regional lymph nodes were found. Based on the survey results, the diagnosis veri�econovan as "Cancer of the left kidney cT 1N0M0". The latter was an indication for surgical treatment in the amount of laparoscopic nephrectomy.
The technique of operation. The position of the patient on the back". Optical trocar in umbilically area. After inspection of the abdomen 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. Formed transtentorial access to the left kidney. Why cut the ligament of Treitz, the peritoneum and tissues mesocolon to form a "window" to the mesentery of the descending colon of oval form, the top of which is limited by v. mesenterica inf, arcus Riolani, a. colicae sin and tail of the pancreas. A fragment of the mesocolon and of the peritoneum on the left kidney. Using the described access selected the mouth of the left renal artery, which is patched up and crossed to the confluence of the abdominal aorta. Then kopirovane and crossed renal vein tributaries. Megascale, the left kidney was entirely mobilized together with the adrenal gland, without compromising the integrity of the fascia Gerota. Ureter allocated to iliac vessels. There is crossed after clipping. Body extracted through a window in the mesocolon and evacuated from the abdominal cavity in the plastic container. Through a "window" in mesocolon colon in the box remote kidneys failed� the lock of the greater omentum. Deathplace. Suture wounds. The operation lasts for 45 minutes. Blood loss volume of 70 ml. Postoperative period without complications. Patient activated on the day of surgery. Recovery of bowel function observed after 10 postoperative hours was held self-formed stools). Blood transfusion and narcotic analgesia was not used. The patient was discharged for outpatient monitoring in a residence on the fifth day after surgery. Control examination after 2 months. According to the ultrasound area surgery without pathology; blood and urine tests within normal limits. The patient feels satisfied, socially and professionally rehabilitated completely.
1. A method for performing a total left nephrectomy, including the implementation of the access to the left kidney, isolation and ligation of the vessels of the kidney, the kidney allocation without compromising the integrity of the fascia Gerota and adipose capsule, the mobilization of the whole kidney and ureter to the level of the common iliac vessels, the ureter is ligated and cut, it is removed, characterized in that the access to the kidney perform by forming an oval window in the mesocolon of the descending colon, the top of which is limited by v. mesenterica inf, arcus Riolani, a. colicae sin and tail of the pancreas, which carried out the dissection of the ligament of Treitz, peritoneum and tissues mesocolon, and the received�th free oval part of the mesocolon and peritoneum leave on the kidney, the body is evacuated through a "window" of the mesocolon, a "window" in mesocolon are not sutured, and the resulting after removal of the kidney cavity in the retroperitoneal space is placed a strand of greater omentum.
2. A method according to claim 1, characterized in that the kidney is mobilized together with the adrenal gland.
3. A method according to claim 1, characterized in that the kidney is mobilized without adrenal gland.
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
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: 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