Improving the technique of pneumovesicoscopic access for the correction of congenital malformations of the lower urinary tract in children
Introduction. In the last decade, technologically complex endovideosurgical intravesical access has been increasingly used to correct malformations of the lower urinary tract. Thus, currently the question of using vesicoscopic access has not been fully resolved, in this regard, the goal of our study was to study the scientific literature on this problem. Materials and methods. In this article, we discuss various options for the technique of performing vesicoscopic access, the instruments used, intra- and postoperative complications and ways to solve them. Based on the results of the selection of articles from the Pubmed and e-library.ru databases, the corresponding request for pneumovesicoscopic ureteral reimplantation in children, articles for the period 1995-2019 were selected: 24 from foreign sources, 5 from Russian. Results. Pneumovesicoscopic approach is used for: vesicoureteral reflux (VUR) or megaureter (ureteral reimplantation), ureterocele (ureterocelectomy with vesicoplasty), bladder diverticulum (diverticulectomy), bladder polyp (polypectomy)etc.Pneumovesicoscopic access is characterized by introducing trocars through the abdominal and bladder walls with fixation by various method. Further insufflation of carbon dioxide in the bladder improves visibility and creates enough space for manipulation with endoscopic instruments.The use of pneumovesicoscopy shortens the length of hospital stay and reduces the intensity of postoperative pain. Postoperative complications include urinary tract infection, urinary extravasation, mild suprapubic and scrotal emphysema, etc. Conclusion. Improvement of the technique for performing pneumovesicoscopic access from 1995 to the present is associated with an increase in the number of manipulation trocars from 1 to 2 and the ability to transurethrally insert another working instrument with a diameter of 3 mm, as well as the method of their installation. Much attention was paid to the methods of fixing trocars to prevent complications associated with loss (displacement) of the portal passage of the videocamera and subsequent accumulation of gas in the paravesical tissue. To do this, it is proposed to suture the muscles of the abdominal wall and urinary bladder with the subsequent introduction of ports or the use of various self-fixing trocars with inflatable balloons. A decrease in age restrictions and the number of complications of operations is possible as surgeons gain experience in performing these surgical interventions, with an improvement and clarification of the reliability of access to the bladder and the quality of fixation of trocars.