Method for laparoscopic colpopexy

FIELD: medicine, gynecology.

SUBSTANCE: through vertical umbilical incision one should introduce an optic trocar supplied with laparoscope, separate peritoneum with gas from pre-peritoneal fiber and through an access developed on should fix anterior vaginal wall to pectineal ligaments from both sides at the level of the middle urethral part and urethrovesical segment by leaving about 1.5-2.5 cm against urethra.

EFFECT: higher efficiency.

1 ex

 

The present invention relates to medicine, in particular for surgical gynecology.

Closest to the proposed method is a method of laparoscopic colorectal lateral access (Slansky. Pozadina laparoscopic colpopexy by Burch. Obstetrics and gynecology, 2000, No. 1) Under General anesthesia with endotracheal intubation, the patient is placed in the lower lithotomy position with the feet placed on the universal podkolennik. Palevsky catheter 18-20 Fhench with a 30 ml balloon tip is introduced into the bladder. After emptying bladder 30 ml of concentrated Indigo Carmine is injected into the bladder. The laparoscope was introduced through the vertical umbilical incision and produce three 5 mm puncture of the anterior abdominal wall on the line connecting spine ischial bones. Two trocar are inserted laterally, away ≈3-4 cm from the spines and one on the middle line. After an internal examination the patient was transferred to a 15° Trendelenburg position and inspect the pelvic organs.

Papadimitrou space obliterat using 2.0 continuous seams in the modification Moschcowitz through the laparoscope. Use at least 2 purse-string suture.

Laparoscopic scissors make an incision of the parietal peritoneum in length ≈3 cm from the round ligament of the uterus to fold perpendicular to the latter. Stupid by formiruet the camping tunnel in paravaginal tissue, and are retroporno space. The benchmarks are: lateral-top - link Kupffer same side, bottom, front wall of the vagina with paravaginal fascia in the region of the anterior arch, medial urethrovesical segment of the bladder. Similar by forming a tunnel on the opposite side.

One U-shaped non-absorbable suture, such as Surgipro 0, stitch, pick up and attract the anterior wall of the vagina anteriorly and upward to a bunch of Kupffer at the level of the middle part of the urethra and vesicourethral segment, departing ≈2 cm from the urethra. Make a stitch through the entire thickness of the front wall of the vagina, without capturing the mucosa and then spend the ligature through Copperhouse ligament located on the same side. Knot tied in vitro using surrounding Clark-rich. The procedure is repeated on the opposite side. Seams delay in the condition of moderate tension.

The disadvantages of this method is the appearance characteristic of postoperative pneumoperitoneum States (“granicus” - symptom for 2-3 days after surgery), the entry in retroporno space of the abdominal cavity and then peritonial, relatively large blood loss and operative time.

The objective of the invention is a method of laparoscopic colpopexy to achieve Retz the eve of the preperitoneal space from access to reduce intraoperative blood loss, operative time, the ability to use the method in the complex surgical treatment with the simultaneous production of radical and plastic surgery on the uterus and perineum vaginal access.

The problem is solved by the method lies in the fact that through the vertical umbilical incision injected optical trocar with a laparoscope and the cutting tool to the peritoneum, gas usepreview the peritoneum from the properitoneal fat to recieve space and through the formed access fixed anterior wall of the vagina to comb the tangles from two sides at the level of the middle part of the urethra, urethrovesical segment, departing ≈2 cm from the urethra.

Practically the method is as follows: under General anesthesia with endotracheal intubation, the patient is placed in the lower lithotomy position with the feet placed on the universal podkolennik. Palevsky catheter 18-20 Fhench with a 30 ml balloon tip is introduced into the bladder. After emptying bladder 30 ml of concentrated Indigo Carmine is injected into the bladder. Through vertical umbilical incision using an optical trocar with a laparoscope and the cutting tool is layered incision of the anterior abdominal wall to the peritoneum. Next, connect the gas (pressure 215 mm Hg), which is self-otdavlyay peritoneum posterior to area recieve space, thereby increasing the working area. Two trocar are inserted laterally, some distance of 3-4 cm from the spines. One U-shaped non-absorbable suture, such as Ethibond 0, stitch, pick up and attract the anterior wall of the vagina anteriorly and upward to a bunch of Kupffer at the level of the middle part of the urethra, vesico-urethral segment, departing ≈2 cm from the urethra. Under the supervision of a finger, introduced into the vagina, make a stitch through the entire thickness of the front wall of the vagina, without capturing the mucosa and then spend the ligature through Copperhouse ligament located on the same side. Knot tied in vitro using surrounding Clark-rich. The procedure is repeated on the opposite side. Seams delay in the condition of moderate tension.

The following example illustrates the method according to the invention

S-VA G.N., 45 years old (case history No. 42), was admitted to the Department of surgical endoscopy 24.01.2000, With complaints of urinary incontinence during exercise, excessive, prolonged menstruation. Diagnosed with multiple fibroids with centripetal growth of one of the nodes, menometrorrhagia, secondary anemia, hypertrophy and scar deformity of the cervix, stress incontinence type II 05.01.2000, Under endotracheal anesthesia made the dena surgery: vaginal hysterectomy without appendages. Laparoscopic pozadina colpopexy preperitoneal access.

Under General anesthesia with endotracheal intubation, the patient is placed in the lower lithotomy position with the feet placed on the universal podkolennik. Palevsky catheter 18-20 Fhench with a 30 ml balloon tip is introduced into the bladder. After emptying bladder 30 ml of concentrated Indigo Carmine introduced into the bladder. Through vertical umbilical incision using an optical trocar with a laparoscope and the cutting tool produced layer-by-layer incision of the anterior abdominal wall to the peritoneum. Further connected to the gas (pressure of CO215 mm Hg), which is self-otdavlyay peritoneum posterior to area recieve space, thereby increasing the working area. Two trocar is introduced laterally, some distance of 3-4 cm from the spines. One U-shaped non-absorbable suture, such as Ethibond 0, stitch, pick up and attract the anterior wall of the vagina anteriorly and upward to a bunch of Kupffer at the level of the middle part of the urethra and vesicourethral segment, departing 1.5-2 cm from the urethra. Under the supervision of a finger, introduced into the vagina did stitch through the entire thickness of the front wall of the vagina, without capturing the mucosa and then spent the ligature through Copperhouse ligament located on the same side. Knot tied in vitro using p is cher Clarke-rich. The procedure was repeated on the opposite side. The sutures were tightened in the condition of moderate tension.

Postoperative period was unremarkable. The Foley catheter is removed after 24 hours. Discharged 02.02.2000, in a satisfactory condition. Started to work after 20 days of operation. During 3 years of observation the results of the operation are satisfied.

The claimed method operated 23 patients with stress incontinence. Laparoscopic colpopexy preperitoneal access was conducted in patients with hypermobility of urethrovesical segment, as well as in moderately expressed cystocele. The age of patients ranged from 45 to 72 years, mean age of the patients was 58.5 years. Patients in postmenopausal women was 11 (58.2 per cent). Duration of disease according to the history ranged from 3 to 25 years.

Examination of patients included clinical tests, a pelvic exam, pelvic ultrasound with the use of vaginal and abdominal sensors with a measurement of urethrovesical angle. Urodynamic examination included a review of the function of the detrusor and urethral to prevent their instability, be a measure of the maximum pressure, the functional length of the urethra. In some cases, cystography was performed. Length of stay in hospital were from 2 to 5 days. Catete the Foley was removed 2 days after surgery. The survey was carried out before surgery and every 6 months during the whole period after the operation. Long-term results were studied in the period up to 6 years, recurrence of stress incontinence is not marked.

Thus, the advantages of this method were:

1. No entry into the abdominal cavity.

2. The absence of characteristic pneumoperitoneum symptoms (pain in the hypochondrium).

3. The possibility gentle mobilization of the bladder using a finger of the surgeon.

4. The ability to use the method in the complex surgical treatment with the simultaneous production of radical and plastic surgery on the uterus and perineum vaginal access.

5. The decrease in blood loss and operative time.

How laparoscopic colpopexy, including vertical umbilical incision, podszywania the anterior wall of the vagina to comb combination with one U-shaped non-absorbable suture, characterized in that in a vertical umbilical incision injected optical trocar with a laparoscope and the cutting tool to the peritoneum, gas usepreview the peritoneum from the properitoneal fat to recieve space and through the formed access fixed anterior wall of the vagina to comb the tangles from two sides at the level of the middle part of the urethra and urethrovesical the high segment departing 1.5-2.5 cm from the urethra.



 

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