METHOD FOR SURGICAL TREATMENT OF PELVIC ORGAN PROLAPSE IN COMBINATION WITH CERVICAL ELONGATION (MOSCOW OPERATION) Russian patent published in 2021 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to operative gynecology. Fixation with bullet forceps and lowering of the cervix are performed. The diameter of the cervical canal is increased with dilators. After that, a midline incision of the anterior wall of the vagina is performed, the vaginal mucosa and the wall of the bladder are separated from the cervix. Channels are formed up to the obturator membranes on both sides. A midline incision of the anterior wall of the vagina is performed, starting below the external opening of the urethra and ending below the expected level of cutting off the cervix. After that, the incision of the anterior wall of the vagina is continued into the distal part in an oval-circular manner so as to form flaps of the vaginal mucosa in the shape of a "swallow tail". In the area of the posterior and lateral walls of the cervix, the incision is extended circularly, followed by separation of the vaginal mucosa from the cervix above the expected level of amputation. Canals are formed to the sacrospinous ligaments on both sides. The descending bundles of the uterine vessels and the lower half of the cardinal ligaments on the left and right are cleared, crossed and ligated, while the sacro-uterine ligaments are left intact. The mobilized elongated part of the cervix is cut off with the formation of a conical depression in the projection of the internal pharynx; titanium fixation devices - "anchors" with double non-absorbable ligatures fixed at the ends of a mesh titanium implant - "Titanium silk" ribbon-shaped - with the help of guides are brought to the sacrospinous ligaments from both sides at a distance from the spinous processes of the ischial bones, the "anchors" are fixed in ligaments, and the central part of the titanium tape is sutured to the posterior wall of the cervix. Then, two titanium mesh implants are additionally used - "Titanium silk" of a ribbon-like shape, the peripheral ends of which are transobturator-driven into the area of the femoral folds on the right and left at the level of the clitoris with the help of guides, and their other ends are fixed to the anterior wall of the cervix with non-absorbable ligatures. Then the cervix is re-formed, for which one separate absorbable Sturmdorf suture is applied to the posterior lip, bringing the vaginal mucosa into the cone-shaped space of the cervical canal, and a screw suture is applied to the front lip, combined with a Donati suture in such a way as to capture a flap of the vaginal mucosa, which was previously excised in the form of a "dovetail". The lateral parts of the cervix are sutured with separate absorbable ligatures. The final cervicosuspension is carried out by pulling the peripheral ends of the implants brought out into the area of the femoral folds on the right and left. The mucous membrane of the anterior vaginal wall is sutured with separate absorbable sutures. The operation is completed by colpoperineolevatoroplasty.

EFFECT: method increases efficiency of surgical treatment by normalizing the topographic localization of the uterus in the pelvic cavity, reducing the frequency of relapses and mesh-associated complications in patients with pelvic organ prolapse in combination with cervical elongation.

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