METHOD OF TRANSURETHRAL RESECTION OF URINARY BLADDER WALL WITH URETERAL ORIFICE WITH APPLICATION OF TULIUM FIBER LASER IN LAPAROSCOPIC NEPHROURETERECTOMY FOR TREATMENT OF PATIENTS WITH HIGH URINARY CANCER OF HIGH DEGREE OF MALIGNANCY

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely to oncourrology. Patient is placed in lithotomy position, external genitals are treated with aseptic solution, resectoscope is performed in urinary bladder. Bladder is filled with 0.9 % sodium chloride solution. Resection limits are determined and a transurethral resection of the bladder wall with the ureter orifice to the adipose tissue using a tulium fiber laser is performed. Hemostasis is performed, resectoscope is removed, urinary bladder is drained with urethral catheter. Patient is laid on his / her side and the surgical site is treated with an aseptic solution, the pararectal line above the umbilicus is followed by abdominal puncture with a Veres needle, a drop-shaped test or a sample with a syringe, carboxyperitoneum is created, after removal of the needle into the above zone, port N10 is installed for the optical telescope and additionally 3 working ports. First port is located along the midclavicular line at 5 cm from the costal arch. Second one is at level of upper anterior iliac spine. Third one is on the level of the middle one-third of the anterior axillary line. Posterior leaf of the parietal peritoneum is dissected parallel to the large intestine with an ultrasonic scalpel, the latter are displaced together with the paracolone medially, a separate separation of the renal vein and artery is performed, clipping of renal artery and vein by clips, placing two clips on proximal stump and one by distal clips. Conversion of renal vessels is performed, after two additional N5 ports are installed along rectal line 5 cm below umbilicus and ureter block is mobilized to urinary bladder by median-clavicular line at navel level. Nephroureterctomy is performed. Adrenal gland is displaced cranially, haemostasis is controlled, the kidney is removed through the incision in the iliac region and the wound is closed in layers. Abdominal cavity is drained with two drainages in the small pelvis and the removed kidney. Exufuction of carbon dioxide from the abdominal cavity is performed, trocars are removed and skin incisions are closed.;EFFECT: method enables reducing intraoperative time costs and blood loss volume, while eliminating the need for closure of the bladder defect in the laser resection area due to its insignificant volumes, and visual control during the endoscopic stage enables more precise resection in the area of interest.;7 cl, 2 ex