METHOD FOR ROBOTIC EXTRALEVATORY ABDOMINAL PERINEAL RESECTION WITH TRANS-ABDOMINAL LEVATOR CROSSING IN THE LITHOTOMY POSITION OF PATIENT

摘要

FIELD: medicine.;SUBSTANCE: robotic total mesorectal excision is performed with extralevatory perineal resection. The patient is placed in a modified lithotomy position in Trendelenburg position with right deviation of the operating table. The organization of the operating room is standard for robotic operations on the rectum, taking into account the surgeon location. In the lithotomical position of the patient under the control of vision and after insufflation with CO₂, 6 ports are installed. Laparoscopes with a viewing angle of 30° and 0°, manipulators and tools are installed. Before the beginning of the pelvic stage of operation, robot manipulators are moved. After rectum isolation and hemostasis, the robot is switched off. The cylindrical preparation is removed in the Trendelenburg position through the crotch section. The small pelvis cavity is drained. A terminal colostomy is formed.;EFFECT: method provides the ability to perform extralevatory perineal resection with total mesorectal excision of trans-abdominal, precision, due to three-dimensional visualization, tissue isolation and levators intersection with minimal risk of urethral, vascular and nerve structures damage in the urogenital diaphragm and pelvic diaphragm, eliminates the need for patient overturning, improves wound healing in the perineal region, shortens the operation time, reduces the risk of intra- and postoperative complications.;6 dwg