METHOD OF CIRCULAR RESECTION OF THE LOWER SEGMENT OF THE UTERUS DURING CAESAREAN SECTION Russian patent published in 2023 - IPC A61B17/42 

FIELD: medicine; obstetrics; gynecology.

SUBSTANCE: after the lower median laparotomy, the lower segment of the uterus is preliminarily separated from the wall of the bladder with hemostasis in the area of aberrant vessels. The anterior sheets of the broad ligaments are opened along the ribs of the uterus from the internal os to the site of attachment of the round ligaments of the uterus. A hysterotomy is performed along the border of visually altered tissues, the fetus is removed. The uterus is removed from the abdominal cavity without attempting to separate the placenta. Complex compression hemostasis is carried out with three tourniquets made of elastic rubber tubes. After that, the degree and topography of placenta ingrowth are assessed and the volume of resection is planned. Bilateral ligation of the vascular bundles is performed along the uterine ribs above and below the intended cut-off line of the lower segment, the ascending uterine arteries are diverted to the sides using thin silicone tubes-holders, the lower segment is circularly excised as a single block with the placenta within healthy tissues. An anastomosis is imposed between the body and the cervix with separate interrupted sutures and continuously. After suturing the uterine wall, the tourniquets and holders are removed. An uterotonic is introduced, defects in the wide ligaments are sutured, sterilization is performed, the small pelvis and abdominal cavity are drained with tubular drains, the anterior abdominal wall is sutured tightly.

EFFECT: method allows saving the uterus and main vessels providing its blood supply, minimizing surgical trauma of the uterus, and reducing intraoperative blood loss.

1 cl, 3 ex