METHOD OF LAPAROSCOPIC METROPLASTY OF THINNED SCAR LESS THAN 3 mm ON UTERUS AFTER CESAREAN SECTION Russian patent published in 2024 - IPC A61B17/42 A61B17/94 A61K8/65 A61K38/36 A61P7/04 

FIELD: medicine; obstetrics; gynaecology; operative gynaecology.

SUBSTANCE: hysteroscopy is performed with visualization of the area of thinned scar from the side of the uterine cavity, a Veress needle is inserted into the abdominal cavity, through which a flow of carbon dioxide flows. Next, a trocar for a laparoscope with a diameter of 10 mm is inserted into the puncture site at a right angle, using a bipolar coagulator and scissors, the retroperitoneal paravesical spaces on both sides and the peritoneum of the uterovesical fold are opened, the bladder is dissected, the bladder is separated from the uterus using sharp and blunt means and cervix to the area of the anterior vaginal vault. Under laparoscopic control, the site of the suspected uterine scar is perforated from the side of the uterine cavity towards the abdominal cavity with a uterine probe. Next, the probe is left in the wound, the scar is excised laterally towards the vascular bundles, the wound on the uterus is sutured, and separate interrupted sutures are applied to the corners of the wound with a polyglycolide thread. Next, the wound on the uterus is sutured with absorbable self-fixing suture material in two rows, the first row is a muscular-muscular continuous suture, a needle is inserted to the depth of the wound, followed by passing the thread to the opposite side with a puncture, retreating 1 cm from the edge of the wound on both sides. Next, on the opposite side, the next injection is made, retreating 5 mm from the previous one, and the thread is passed to the opposite side, repeating until the wound is completely sutured, the second row is a seromuscular continuous suture, using the same thread, suturing is continued in the opposite direction, retreating 1 cm from the edge of the wound, make an injection with a puncture on the opposite side, repeating until the wound is completely sutured, the last step is completed by cutting the thread 3 mm from the edge of the wound without tying a knot, the haemostatic matrix is removed from the sterile packaging, grabbed with a laparoscopic clamp and inserted into the abdominal cavity through a trocar 10 ml in the left iliac region. The haemostatic matrix with the white side is applied to the site of the formed suture along its entire length, overlapping the boundaries of the suture on the uterus by 1 cm, pressed over the entire surface of the pad for 2 minutes, and intraoperative hysteroscopic control is performed.

EFFECT: reliable comparison of wound edges with preservation of the architectonics of the muscular wall with the formation of a healthy postoperative scar, elimination of the appearance of dead spaces, reliable haemostasis, which reduces the amount of intraoperative blood loss and the risk of coagulation necrosis when using bipolar coagulation, and also reduces the duration of surgical treatment.

2 cl, 1 ex