METHOD FOR PREVENTION OF PREMATURE MISCARRIAGE FOLLOWING RADICAL TRACHELECTOMY WITH PRESERVING ASCENDING BRANCHES OF UTERINE ARTERIES Russian patent published in 2016 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: uterovesical fold is incised through a laparoscopic approach. The urinary bladder is mobilised at 11-16 mm downwards with separating it from the anterior surface of the uterus and limiting the mobilisation area by the medial border of the parametrium from each side. Anterolateral portions of an uterovaginal anastomosis are separated. The peritoneum is incised within the posterior wall of the uterovaginal anastomosis with extending the incision from each side up to the uterosacral ligament, and a polypropylene flap 11-14 mm wide is introduced into the abdominal cavity. A perforator is used to form a tunnel from one side of the uterus between the side wall of the uterovaginal anastomosis and the ascending branch of the uterine arteries by perforating the anterior abdominal wall in the anteroposterior direction by directing the perforator at an angle of 80-100 degrees to the long axis of the uterus and bringing the end of the perforator into the abdominal cavity behind the uterus. When perforating the anterior abdominal wall, the perforator is introduced by 4-5 cm above the pubic and by 1-2 cm in the lateral direction from the projection of the abdominal line onto the anterior abdominal wall. The perforator grips one of the flap ends; it is retracted back to front through the formed tunnel and fixed on the anterior wall of the uterovaginal anastomosis by means of an extracorporeal suture. The similar technique is used to form a tunnel from the other side of the uterus, and the second end of the flap is delivered through. The flap is laid completely around the uterovaginal anastomosis with fixing the second end of the flap by means of the extracorporeal suture on the anterior wall of the uterovaginal anastomosis, making the flap tensed along its full length. The peritoneum integrity is restored by isolating the uterovaginal anastomosis from the abdominal cavity. The propylene flap represents the GyneMesh Soft polypropylene flap. The perforator is the Berci suture instrument.

EFFECT: method ensured simplifying the technique of uterus cerclage with maintaining its reliability and prevents the complications caused by the perforation of parauterine tissues.

4 cl, 2 ex