METHOD OF METROPLASTY IN FEMALES WITH DIFFUSE-NODULAR ADENOMYOSIS Russian patent published in 2019 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: invention relates to obstetrics and gynaecology. Laparoscopy is performed with installation of two working trocars in the right and left iliac regions and one central trochanam in the para-ulbical region. Abdominal cavity is inspected, a serous uterine membrane, a myometrium to an adenomatous changed myometrium and a uterine cavity are dissected by a longitudinal contour length of 5 cm in a direction from a uterus to a uterine cervix in a direction from a uterus to a neck of a uterus by a monopolar hook in a mode of coagulation by a semilunar incision. That is followed by additional incisions of the serous membrane and myometrium 3 cm long from the upper and lower points of the longitudinal incision in the transverse direction towards the greatest lesion of the myometrium to form lateral flaps of myometrium on the left and to the right and the most complete excision of the altered tissues. Thereafter, the adenomyoscopically changed tissue is excised with the help of an L-shaped monopolar dissector until diffuse bleeding of myometrium with 5 mm of the myometrium leaving the uterine cavity and 8 mm from the uterus serous membrane, thus forming a flap on the right and a flap on the left. Serous membrane on one of the flaps is excised with the help of a monopolar coagulant, respectively, of the inner surface of the contralateral flap. Uterine cavity is opened to control the excision limits of the changed portion of the myometrium relative to the uterine mucosa. Then the uterine cavity is closed with separate vicryl sutures 3-0. Flap with an excised serous membrane is pulled up to the base of the inner surface of the contralateral graft by means of three U-shaped sutures Vicryl 1-0, 1.5 cm from each other. Overlapped contralateral flap is fixed to the serous surface of the other flap by separate vicryl sutures at distance of 1.5–2 cm from each other, thus forming a uterine wall with duplication formation, the suture line is peritonized, haemostasis is performed, the sutures are closed on the skin.

EFFECT: method enables improving the functional condition of the uterine wall (myometrium) and further scar formation with the conditions of preventing its inconsistency, reducing intraoperative injuries.

1 cl, 3 ex, 1 dwg