RU-2861533-C1 - METHOD FOR EXTRA-PERITONEAL ENDOSCOPIC ACCESS TO RETROMUSCULAR SPACE DURING HERNIA REPAIR OF ANTERIOR ABDOMINAL WALL

RU2861533C1RU 2861533 C1RU2861533 C1RU 2861533C1RU-2861533-C1

Abstract

FIELD: medicine; surgery. SUBSTANCE: during hernia repair of the anterior abdominal wall, performing a transverse incision of the skin, subcutaneous fat and the anterior layer of the lateral part of the upper third of the rectus sheath on the right or left side of the anterior abdominal wall. Performing blunt separation of the bundles of the rectus abdominis muscle. Inserting a trocar through the formed channel. Injecting carbon dioxide into the retromuscular space through the trocar. Inserting a laparoscope connected to a camera into the trocar. Under visual control, blindly performing dissection behind the posterior layer of the rectus abdominis sheath in the caudal direction. On the same side of the anterior abdominal wall, 2 cm below the level of the navel, in the lateral part of the rectus abdominis sheath, making another incision of the skin, subcutaneous fat and the anterior layer of the rectus abdominis sheath. Through the resulting channel, inserting another trocar into the previously formed space, through which a cutting tool is inserted. Using the cutting tool, performing dissection along the posterior wall of the rectus abdominis sheath to the medial edge of the rectus abdominis muscle. Above the level of the navel, incising the medial edge of the rectus abdominis sheath with penetration into the preperitoneal fat. Carrying out all the above steps also on the opposite side of the anterior abdominal wall. Combining both retromuscular spaces with each other and with the preperitoneal fat into a single cavity. EFFECT: formation of an extraperitoneal endoscopic access to the retromuscular spaces during hernia repair of the anterior abdominal wall, simplifying the process of dissection and combining the retromuscular spaces into a single space in the preperitoneal layer. 1 cl, 3 dwg, 2 ex

Inventors

KARTASHEV ALEKSANDR ALEKSANDROVICH

Dates

Publication Date: 20260505
Application Date: 20250321

Claims (1)

A method of extraperitoneal endoscopic access to retromuscular spaces in the plastic surgery of hernias of the anterior abdominal wall, characterized by the fact that a transverse incision is made in the skin, subcutaneous tissue and the anterior leaflet of the lateral part of the upper third of the sheath of the rectus abdominis muscle on the right or left side of the anterior abdominal wall, then a blunt separation of the bundles of the rectus abdominis muscle is performed and a trocar is installed through the formed channel, carbon dioxide is pumped into the retromuscular space through the trocar, then a laparoscope connected to a camera is inserted into the trocar, and, under visual control, a blunt dissection is performed above the posterior leaflet of the sheath of the rectus abdominis muscle in the caudal direction, then, on the same side of the anterior abdominal wall, 2 cm below the level of the navel in the lateral part of the sheath of the rectus abdominis muscle, another incision is made in the skin, subcutaneous tissue and the anterior leaflet of the sheath of the rectus abdominis muscle, through the formed channel in another trocar is inserted into the previously formed space, through which a cutting instrument is installed; with the cutting instrument, a dissection is performed along the posterior wall of the sheath of the rectus abdominis muscle to the medial edge of the rectus abdominis muscle; above the level of the navel, a dissection is made of the medial edge of the sheath of the rectus abdominis muscle with penetration into the preperitoneal tissue; then all the indicated techniques are also carried out on the opposite side of the anterior abdominal wall, and then the unification of both retromuscular spaces with each other and the preperitoneal tissue into a single cavity is carried out.

Description

The invention relates to medicine and surgery, namely to herniology, and is intended to improve the results of surgical treatment of patients with hernias of the anterior abdominal wall. Currently, many methods have been developed for treating hernias of the anterior abdominal wall using endoscopic access. Some of these are extraperitoneal - TEP and eTEP (Totally Extraperitoneal Procedure and extended Totally ExpraPeritoneal Procedure). The essence of both methods lies in dissection in the space located in the sheath of the rectus abdominis muscles behind the muscles - the so-called retromuscular space (Rives-Stoppa procedure). To access it, an incision is made in the skin, subcutaneous tissue and the outer leaflet of the aponeurosis of the sheath of the rectus abdominis muscle on one of the sides. Then, through the resulting channel into the retromuscular space, a trocar is inserted through which a laparoscope connected to a video camera is introduced and carbon dioxide is pumped. Then, blunt dissection is performed to the level of the umbilicus, where another trocar is inserted through which a cutting instrument (monopolar hook, ultrasonic scalpel) is introduced, with the help of which further tissue isolation is carried out to the medial edge of the sheath of the rectus abdominis muscle. Next, in the supraumbilical region, the medial edge of the rectus sheath aponeurosis is incised, opening the preperitoneal space. Dissection continues in the preperitoneal layer until the outer edge of the opposite rectus sheath is reached. This is then incised and the retromuscular space of the opposite side is entered, where dissection is then continued. When the lateral edge of the rectus sheath is reached and sufficient space is freed for instrumentation, a third trocar is inserted at the top and a second dissection instrument is installed. After this, dissection is performed caudally in the formed combined retromuscular and preperitoneal space (Endoscopic extraperitoneal approach (eTEP) for correction of diastasis of the rectus abdominis muscles and concomitant median ventral hernias / V. A. Burdakov, S. A. Makarov, A. S. Kupriyanova [et al.] // Plastic surgery and aesthetic medicine. - 2020. - No. 3. - P. 16-24. - DOI 10.17116/plast.hirurgia202003116. - EDN SOHKDT). The disadvantages of the known method are the following: - difficulty in visualizing the edge of the rectus abdominis sheath opposite the first incision and the likelihood of disruption of the integrity of the peritoneal lining (this will lead to gas penetrating into the abdominal cavity, which will reduce the pressure in the working space and further complicate visualization, and will also require a labor-intensive process of suturing the defect), - in the presence of a large hernial sac or previous surgical interventions in the preperitoneal and retromuscular space, there may be adhesions, the dissection of which may be difficult, since with the traditional method, access to them is possible only from one side. The objective of the invention is to create a method for extraperitoneal endoscopic access to the retromuscular space during plastic surgery of anterior abdominal wall hernias, achieving a technical result consisting in improving the results of surgical treatment of patients with anterior abdominal wall hernias by simplifying the process of access to the retromuscular spaces, their dissection and unification into a single space in the preperitoneal layer, which significantly simplifies and accelerates the process of isolating the hernial sac by improving visualization and reducing the risk of its damage, especially in the presence of adhesions with muscles or fascial sheets. The technical result is achieved in that the method of extraperitoneal endoscopic access to retromuscular spaces during plastic surgery of hernias of the anterior abdominal wall includes a transverse incision of the skin, subcutaneous tissue and the anterior leaflet of the lateral part of the upper third of the sheath of the rectus abdominis muscle on the right or left side of the anterior abdominal wall, then blunt separation of the bundles of the rectus abdominis muscle is performed and a trocar is installed through the formed channel, carbon dioxide is pumped into the retromuscular space through the trocar, then a laparoscope connected to a camera is inserted into the trocar, and, under visual control, blunt dissection is performed over the posterior leaflet of the sheath of the rectus abdominis muscle in the caudal direction, then, on the same side of the abdominal wall, 2 cm below the level of the navel in the lateral part of the sheath of the rectus abdominis muscle, another incision is made in the skin, subcutaneous tissue and the anterior leaflet of the sheath of the rectus abdominis muscle, through the formed channel in another trocar is inserted into the previously formed space, through which a cutting instrument is installed; with the cutting instrument, a dissec