METHOD FOR SURGICAL MANAGEMENT OF BARTHOLIN'S GLAND CANCER Russian patent published in 2024 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgical oncogynecology. Transverse skin incision is made in a projection of a femoral triangle, 2 cm below and 2 cm medial to an anterior superior iliac spine, with simultaneous excision of skin of inguinal fold 3.0–5.0 cm wide, completing the incision on the genitofemoral fold. Then the lower fascial skin flap is removed along the superficial leaf of the superficial hip fascia in a projection of the femoral triangle, and the upper one – along the superficial leaf of the superficial abdominal fascia 4–6 cm above and along the inguinal ligament. Then, in a projection of the thigh deep into a deep leaf of the fascia lata with its dissection, medially – along the long adductor muscle of the thigh, laterally – along the tailor's muscle, and in the projection of the abdomen deep into the aponeurosis; further, the removed preparation is mobilized towards the femoral vessels and dissected before the inflow of the greater saphenous vein into the femoral vein, displaced medially towards the vulva; the femoral vessels are covered with the displaced tailor's muscle. Skin incision is continued along the border of the anterior and middle one-third of vulva at 0.3–0.5 cm below the urethra to the opposite genitofemoral fold by mobilization to a depth of the superficial fascia of the perineum. Incision is continued along the genitofemoral folds on the right and on the left, with excision of the perineum to the anus, then the tissue block is separated at the level of the superficial fascia of the perineum to the pelvic floor muscles. Lower one-third of vagina is mobilized, tissues of ischiorectal fossa with enclosed tumour are excised, superficial and deep transverse muscles of perineum, bulbospongiosus, ischiocavernosus muscle, levator ani, and external anal sphincter are resected. Postoperative wounds are closed in layers; the residual wound within the vulva is covered with pedicled fasciocutaneous flaps on the posterior surfaces of the thighs.

EFFECT: method provides removal of primary tumour and lymph nodes with observance of principles of anatomical zoning and sheathing, which leads to reduced risk of recurrence and metastasis of tumour; due to preservation of the anterior one-third of the vulva and the clitoris, the proposed method is an organ-preserving radical operation, wherein the non-removed anterior one-third of the vulva and the retained clitoris improve the cosmetic effect and do not lead to the disappearance of orgasm; almost completely eliminates the risk of wound suppuration and significantly improves functional and cosmetic results after surgical treatment.

1 cl, 2 ex