METHOD OF LAPAROSCOPIC MYOMECTOMY WITH GIANT SIZES OF UTERINE MYOMA

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, specifically to surgical gynecology. Carry out the removal of myoma nodules from the abdominal cavity using morcellator. In this case, the surgeon is located to the right of the patient, sets the port for the laparoscope at the point of Hasson, located at the intersection of the middle mammary line and a point 3 cm below the left costal arch, and working ports for instruments: the central port – at the umbilical point, the left and right lateral ports – above typical McBurney points, due to their projection onto the horizontal through the umbilical point. Then, a two-stage hydropreparation is performed before the incision is made on the uterus with a solution consisting of norepinephrine 0.00001 %, Methylergobrevin 2.0 ml, 0.9 % physiological saline solution 100 ml. Next, a cut in the uterus is performed above the maximum diameter of the node in the longitudinal direction of the 1st muscular layer of the uterus and in the transverse direction of the 2nd muscular layer of the uterus along the main muscle fibers and their accompanying vessels, and enucleation of myoma nodes is performed using a harmonic ultrasonic scalpel. Then, the myometrium is sutured with separate endosutures in two layers using a monofilament suture which is made of Monocryl 0 with the largest needle size. In this case, the closure is performed with the left hand from the central and left side port. Suturing the inner layer, made in the transverse direction, is performed from top to bottom, perpendicular to the incision. And the closure of the outer layer of the myometrium is performed from left to right, perpendicular to the incision. Then an anti-adhesive membrane of polyoxidized starch is placed on the line of stitches on the uterus. Hysteroscopy is performed to exclude the suture penetration into the uterine cavity.;EFFECT: method allows to improve the results of treatment, reduce blood loss, form a full-fledged scar on the uterus.;1 cl, 14 dwg, 1 ex