Surgery on the cervix

For any operation, the cervix is exposed in the mirrors. The vagina and cervix are treated with iodonate and ethyl alcohol, the cervix is taken on bullet forceps and reduced to the area of the vaginal opening. Long mirrors are replaced by short wide ones, since they do not allow the cervix to be lowered sufficiently freely. One short wide mirror inserted from the side of the perineum is sufficient. From the sides, lifts are introduced, which the assistants dilute to the sides and thus give the operator the opportunity to work freely. If necessary, the elevator is also introduced from the side of the bosom. After the cervix is accessible, proceed to surgery.

[1],

The plasticity of the vaginal part of the cervix (Emmett's operation, trachelorrhaphia)

Indications: old lateral ruptures of the cervix without deformity and hypertrophy of the cervix, reversal of the cervical canal.

The most common operation in the presence of old cervical lateral ruptures. The technique of the operation is as follows. The cervix is exposed in the mirrors. The front and back of her lips are taken by bullet forceps. A cut is made along the edge of the mucous membrane of the cervical canal. The incision should be up to 1 cm deep, if necessary with excision of ruby tissue. 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 of the uterus from the side of the vagina. With a bilateral break, the operation is performed on both sides.

Removal of cervical canal polyp (polipotomia)

Technique: the front lip of the cervix is captured by bullet forceps. If the size of the polyp is large, it intersects at the base, with small ones, it is grasped by forceps or an abortion, and unscrewed by turning 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 coli uteri)

Indication: ectropion, cervical deformity, chronic cervicitis with cervical hypertrophy, chronic cervicitis with the presence of recurrent polyps, leukoplakia, erythroplasty, recurrent erosion of the cervix.

[2], [3]

Vaginal amputation of the vaginal part of the cervix (Schroeder's operation)

After proper treatment, the cervix is exposed in the mirrors, the front and back lips are gripped with bullet forceps and the neck is lowered to the entrance to the vagina. Before the neck is lowered, the long rear mirror is replaced with a short one, since the long one moves the cervix downward into the vagina, which hinders the manipulation of the surgeon.

Measure the length of the uterine cavity along the probe and mark the part of the cervix, which should be removed. The scalpel is symmetrically dissected across the vaginal part of the cervix. The incision is made from the cervical canal in both directions to the outside until the lateral arches. The vaginal part of the cervix is divided into two parts. The anterior half of the cervix is wedged in such a way that the incision of the mucous membrane of the cervical canal passes 1.5-2 mm deeper than the outer part of the wedge, and several separate the mucous membrane of the vagina upward. Due to this, the outer throat is easily formed and the ectropion is not formed in the future.

After the wedge-shaped section of the anterior lip of the cervix with the help of three separate sutures by the absorbable suture material, the cervical tissue is sewn to the area of the internal pharynx. The first suture is applied along the middle line, stitching the needle from the side of the mucous membrane of the vaginal fornix and puncturing through the mucous membrane of the cervical canal. The seam is not tied, but taken to the clamp. Using this seam as a holder, two seams are applied to the sides of it a little radially, inserting the needle from the side of the mucous membrane of the vaginal vault.

Then the posterior lip is wedge-shaped. Bleeding is stopped. Stitches are applied in the same way as on the front lip of the cervix. After putting all the seams, they tie them and take them to the clamp. Then sidewise lateral sections of the cut. At the outer corner of the brine, a clasp of Kocher is applied and, stretching the wound with this clamp and the central seams, apply and tie the side seams from one side and the other.

Ligatures are cut off, urine is released through the catheter, and the vagina is drained.

Cone amputation of the cervix in Sturmdorf

With bullet pincers, the cervix is reduced to the entrance to the vagina. A circular incision of the vaginal mucosa is made with a scalpel 1 cm above the border of the affected area. The pointed scalpel is excised as a cone towards the inner throat and the part of the affected neck, the mucous membrane of the cervix, muscle tissue and a significant part of the cervical canal are removed.

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

The first suture is carried through the front edge of the incision of the vaginal part of the cervix, leaving 1 cm from it. Both ends of the thread are passed into separate needles, which are punctured from 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, , 5 cm from the edge of its incision. If necessary, the bladder is removed upward by the required distance. When tying the seam, the cut off mucous membrane of the vagina must cover the wound surface both front and back.

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

[4], [5]