SALPINGECTOMY METHOD Russian patent published in 2024 - IPC A61B17/42 A61B34/00 A61B5/522 A61B8/14 

FIELD: medicine; operative gynecology.

SUBSTANCE: preoperative stage is performed, including: transvaginal 3D-echography in modes of color and energy Doppler mapping in order to determine the size, localization and features of the blood supply of the fallopian tube and ovary, and magnetic resonance imaging with contrast enhancement of the pelvic organs in order to determine the size, localization and features of blood supply of the fallopian tube and ovary. Creation of 3D-model of uterine appendages with determination of peculiarities of uterine tube and ovary blood supply. Intraoperative stage, including application of pneumoperitoneum with control of insufflated gas at pressure of 12–13 mm Hg, installation of port 1, 10 mm, 2 cm above and 2 cm to the left of the navel along the left medioclavicular line, transferring the patient to the Trendelenburg position, in the McBurney's points on the left, port 2, 5 mm is installed, on the right, port 3, 5 mm, and additional port 4, 5 mm, 3 cm above the line drawn between the McBurney's points, and 3 cm to the right of the line between the navel and the line connecting the McBurney's points, a laparoscopic visual assessment of the uterine appendages using 30-degree optics. Transfer of visual intraoperative picture of uterine appendages in 3D-model of uterine appendages. Comparison of 3D model with intraoperative data of uterine appendages and creation of navigation marks taking into account peculiarities of blood supply of fallopian tube and ovary. Performing salpingectomy with intraoperative navigation without damaging the perivascular complex while preserving the ovarian reserve, wherein a surgeon works through ports 2 and 4, an assistant works through ports 1 and 3, atraumatic clamps are inserted into ports 2 and 3, an instrument for bioplastic, or argon, or laser coagulation, or endoscopic scissors is introduced into port 4. Then left uterine tube is removed: non-traumatic clamp from port 3 mobilizes the tube in the proximal portion at distance of 1 cm from the uterus, a similar clamp from port 2 mobilizes the left fallopian tube at distance of 2 cm from the fimbrial portion, simultaneously surgeon and assistant pull up fallopian tube for tension of mesosalpinx, then the anterior and posterior leaves of the mesosalpinx in the avascular zone under the intraoperative navigation by the sharp and blunt way are stratified by the branches of the endoscopic scissors, then blunt displacement of perivascular complex with anterior leaf from area of fallopian tube in direction of ovary, then posterior leaf of mesosalpinx at fallopian tube is dissected, method involves coagulation and transection of an uterine tube angle, after which the tube is removed from the abdominal cavity in an endobag. Then, right tube is removed: by non-traumatic clamp from port 2, tube is mobilized in proximal part at distance of 1 cm from uterus, similar clamp from port 3 mobilizes the right fallopian tube at distance of 2 cm from the fimbrial segment, simultaneously the surgeon and the assistant pull up the fallopian tube for tension of the mesosalpinx, then the anterior and posterior leaves of the mesosalpinx in the avascular area of the fallopian tube under intraoperative navigation by a sharp and blunt way are layered with branches of endoscopic scissors. Further, the perivascular complex is displaced bluntly from the fallopian tube in the direction of the ovary, then the posterior leaf of the mesosalpinx at the fallopian tube is dissected, after that, coagulation and intersection of the uterine angle of the fallopian tube is carried out, after which the tube is removed from the abdominal cavity in the endobag.

EFFECT: method enables detecting features of blood supply of the fallopian tube and ovary and performing salpingectomy without damaging the perivascular complex of the fallopian tube and ovary; innovative technologies of modeling and navigation allow performing salpingectomy without reduction of ovarian reserve.

1 cl, 5 tbl, 5 ex