Cervical surgeries

To perform any operation, the cervix is exposed in mirrors. The vagina and cervix are treated with iodonate and ethyl alcohol, the cervix is taken with bullet forceps and lowered to the area of the vaginal entrance. Long mirrors are replaced with short wide ones, since they do not allow the cervix to be lowered freely enough. One short wide mirror inserted from the perineal side is sufficient. Lifters are inserted from the sides, which the assistants move apart, thus allowing the operator to work freely. If necessary, a lifter is also inserted from the pubic side. After the cervix is accessible, the operation begins.

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Plastic surgery of the vaginal part of the cervix (Emmett's operation, trachelorrhaphia)

Indications: old lateral ruptures of the cervix without deformation and hypertrophy of the cervix, eversion of the cervical canal.

The most common operation in the presence of old lateral ruptures of the cervix. The technique of the operation is as follows. The cervix is exposed in mirrors. Its anterior and posterior lips are taken with bullet forceps. An incision is made along the edge of the mucous membrane of the cervical canal. The incision should be up to 1 cm deep, with excision of rubi tissue if necessary. After this, sutures are applied in such a way that the first row forms the cervical canal, and the second is located on the cervix from the vaginal side. In case of a bilateral rupture, the operation is performed on both sides.

Removal of cervical polyp (polipotomia)

Technique: the anterior lip of the cervix is grasped with bullet forceps. If the polyp is large, it is cut at the base; if it is small, it is grasped with forceps or abortion forceps and unscrewed by rotating the instrument in one direction. Subsequent scraping of the mucous membrane of the cervical canal and the polyp bed with a curette is mandatory.

Amputation of the cervix (amputatio colli uteri)

Indications: ectropion, deformation of the cervix, chronic cervicitis with cervical hypertrophy, chronic cervicitis with recurrent polyps, leukoplakia, erythroplakia, recurrent erosion of the cervix.

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Wedge amputation of the vaginal portion of the cervix (Schröder operation)

After appropriate treatment, the cervix is exposed in the mirrors, the anterior and posterior lips are grasped with bullet forceps, and the cervix is lowered to the entrance to the vagina. Before lowering the cervix, the long posterior mirror is replaced with a short one, since the long one moves the cervix deeper into the vagina, which interferes with the surgeon's manipulations.

The length of the uterine cavity is measured using the probe and the part of the cervix that should be removed is marked. The vaginal part of the cervix is symmetrically dissected transversely with a scalpel. The incision is made from the cervical canal in both directions outward to the lateral fornices. The vaginal part of the cervix is divided into two parts. The anterior half of the cervix is cut off in a wedge shape so that the incision of the mucous membrane of the cervical canal is 1.5-2 mm deeper than the outer part of the wedge, and the mucous membrane of the vagina is separated slightly upward. Due to this, the external os is easily formed and ectropion does not form in the future.

After a wedge-shaped section of the anterior lip of the cervix, the cervical tissue is sutured to the area of the internal os using three separate sutures with absorbable suture material. The first suture is placed along the midline, inserting the needle from the side of the mucous membrane of the vaginal fornix and piercing it through the mucous membrane of the cervical canal. The suture is not tied, but taken with a clamp. Using this suture as a holder, two sutures are placed on the sides of it, slightly radially, inserting the needle from the side of the mucous membrane of the vaginal fornix.

Then the posterior lip is cut off in a wedge shape. The bleeding is stopped. The sutures are applied in the same way as on the anterior lip of the cervix. Having applied all the sutures, they are tied and taken with a clamp. Then the lateral sections of the incision are sutured. A Kocher clamp is applied to the outer corner of the wound and, having stretched the wound with this clamp and the central sutures, the lateral sutures are applied and tied on one side and the other.

The ligatures are cut off, urine is released through the catheter, and the vagina is dried.

Cone amputation of the cervix according to Sturmdorf

The cervix is lowered to the vaginal entrance using bullet forceps. A scalpel is used to make a circular incision in the vaginal mucosa 1 cm above the border of the affected area. A sharp-tipped scalpel is used to make a cone-shaped excision toward the internal os and remove part of the affected cervix, the mucous membrane of the cervix, muscle tissue, and a significant portion of the cervical canal.

The mucous membrane of the vaginal part of the cervix is separated from the muscle tissue with a scalpel over a length of 1.5-2 cm or more so that its edge can be stretched and connected to the edge of the mucous membrane of the cervical canal.

The first suture is passed through the anterior edge of the incision of the vaginal part of the cervix, stepping back 1 cm from it. Both ends of the thread are threaded into separate needles, which are pricked out of the cervical canal through the thickness of the muscular wall in the formed funnel to the outside and through the mucous membrane of the vaginal part, stepping back 2-2.5 cm from the edge of its incision. If necessary, the urinary bladder is separated upward to the required distance. When tying the suture, the separated mucous membrane of the vagina should cover the wound surface both in front and behind.

The advantage of cone-shaped amputation of the cervix is that almost the entire mucous membrane of the cervical canal is removed along with part of the cervix. After the operation, the cervix has the correct shape.

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