SURGICAL APPROACH FOR VESICO-URETERIC ANASTOMOSIS

摘要

FIELD: medicine, surgery.;SUBSTANCE: oblique incision of skin is made in iliac region through the line connecting anterior superior iliac spine with tubercle's brim of pubic bone, note that it is made from 1-2 cm in a lateral direction from the outside edge of rectus and continued for 3-4 cm in a medial direction. The skin wound is laterally shifted with disruption of hypoderm over 4-5 cm from aponeurosis of abdominal external oblique muscle, which is dissected at the same length. Abdominal internal oblique muscle and transverse muscle of abdomen are split in a longitudinal direction of fibers. Retroperitoneoscope (RPS) is placed in the wound. Transverse fascia of abdomen is dissected. Peritoneal sac is drawn medially by the blade of RPS forming wound tract to retroperitoneal space. Ureter is defined. RPS is raised into the skin wound. It is shifted by the blade of RPS medially and downward till abdominal raphe is exposed in the region of above pubes with disruption of hypoderm over 4-5 cm from aponeurosis of abdominal external oblique muscle, which is dissected for 4-5 cm from abdominal raphe or in a transrectal way. Recti are split. RPS is moved to Retzius's cavity. The transitional fold of peritoneum is drawn upward forming wound tract to urinary bladder. Frontal wall of urinary bladder is opened and dissected.;EFFECT: possibility to perform vesico-ureteric anastomosis from small section, decrease of tissue damage of frontal abdominal wall and small pelvis.;2 dwg, 1 ex