LAPAROSCOPIC BILATERAL HYSTEROCERVICOCOLPOSUSPENSION USING TITANIUM MESH IMPLANTS IN PATIENTS WITH APICAL PROLAPSE

摘要

FIELD: medicine. ;SUBSTANCE: invention relates to medicine, namely to operative gynecology. A laparoscopic approach enters the abdominal cavity, performs short incisions and inserts three trocars at typical points: the lower edge of the umbilicus and on both sides of the inguinal-iliac region. With laparoscopic means and under visual control, the pelvic organs are revised and passages from the aponeurosis are formed extraperitoneally on both sides in the direction of the uterus, cervix or vagina. Two ribbon-shaped mesh implants, 20 cm long and 1 cm wide, made of polyfilament or monofilament suture made of titanell alloy - VT-1.00 or VT6, are inserted into the formed lateral incisions (1 cm) on the right and left retroperitoneally with the help of conductors. For patients with a preserved uterus, the ends of the implant tapes are placed under the round ligaments, up to the point where they leave the uterus on both sides, the ends of the tapes are localized and fixed to the lateral wall of the uterus at the base of the round ligaments with non-absorbable ligatures made of Etibond type material. For patients after hysterectomy, the ends of the implant tapes are placed in the area of ​​the cut round ligaments, the ends of the tapes are localized and fixed to the cervical stump or to the vaginal dome and to each other also with Etibond ligatures so that the ends of the tapes are fixed to the cervical stump or to the vaginal dome formed a single support apparatus. The physiological position of the uterus, cervical stump or vaginal dome is restored under bilateral - laparoscopic and transvaginal - visual control, pulling on the peripheral ends of the implant bands, reaching a symmetrical position relative to the terminal line. Then, bending the ends of the implant bands and / or pressing them to the aponeurosis, the excess bands are cut off. The incisions are sutured, surgery is completed.;EFFECT: method makes it possible to reduce the complexity of the surgical intervention and the time required for the operation, to reduce its trauma and blood loss, to improve tissue healing, accordingly, the duration of the postoperative rehabilitation period of the patient is reduced, the possibility of complications and relapses is excluded.;5 cl, 2 dwg, 2 ex