METHOD OF LAPAROSCOPIC VAGINOPEXY USING A MESH IMPLANT Russian patent published in 2018 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to gynecology. Perform standard laparoscopy with the installation of two working lateral trocars in the left and right iliac regions and one central in the paraumbilical region. Then the pelvic peritoneum is dissected by an oval incision on the border between the vagina and the rectum, without going beyond the borders of the sacro-uterine ligaments. Fatty tissue of the rectovaginal space is blunt and sharp with the use of a bipolar coagulator and scissors divided to the exposure of the muscles, raising the rectum to the left and right. Model is cut out from the prolene mesh, the long branches are pre-twisted and stitched with a prolene thread, after which the model is placed in the abdominal cavity. Next, the central “tongue” of the model is fixed to the front wall of the vagina with four separate sutures, the model's legs are straightened and their distal sections are fixed to the levator muscles with the help of a herniostepler. Next, the grid is fixed to the back wall of the vagina with four separate seams. Central suture fixes the middle part of the model's tail and the middle zone of the posterior vaginal wall. Then, the proximal edges of the “tail” of the model are fixed with two separate sutures to the side walls of the vagina, then additional punctures of the skin of the anterior abdominal wall are made, located along the anterior axillary line 3–4 cm above the front iliac bones, and form a tunnel: a soft laparoscopic clamp is held in the skin punctures from the outer edge of the external oblique abdominal muscle. Then, retroperitoneally along the walls of the pelvis, between the sheets of the peritoneum of the wide uterine ligaments, above the sacro-uterine ligaments and exit into the previously created defect of the peritoneum in the rectovaginal space. After which the prolene thread fixing the left wing of the model is cut through and the wing is unfolded. Distal end of the left wing of the model is captured with a soft-clamp held retroperitoneally and, under visual control, is brought to the anterior abdominal wall above the skin. Next, with two sutures, the sacro-uterine ligaments are stitched to the proximal sections of the model's wings, and then the peritoneal defect of the rectovaginal and vesicular-uterine space is sutured with two semi-set sutures. Then, desuflation is performed and the model's wings stretch as much as possible, and the excess ends of the mesh are cut off and not hemmed, after that trocar wounds, additional injections are sutured tightly.

EFFECT: method allows to prevent development of persistent pain syndrome after the operation, the back sling does not interfere with the subsequent necessary surgical interventions on the anterior abdominal wall.

1 cl, 3 ex