Surgery on the appendages of the uterus

Indication: tubal pregnancy, hydro- and pyosalpinx, sterilization, benign and malignant neoplasms of ovaries, ovarian apoplexy, sclerocystosis ovary syndrome, infertility.

Technically, the operation on the appendages of the uterus can be simple, but in some cases it is complicated by numerous spikes.

If it is difficult to remove the tumor of the ovary to the wound, two tuppers can be used on the corncang and, bringing them under the tumor. Carefully remove it from the abdominal cavity. The formation of very large dimensions can be reduced by puncturing it with a trocar connected to an electric pump. Preliminary it is necessary to impose a suture stitch. To tighten it after removing the trocar.

Tumor of the ovary after removal must be opened in the operating room to inspect the inner surface of the capsule, since in some cases on the inner surface of the capsule of smooth-walled mobile tumors there are papillary growths. Presence of brittle, easily bleeding papillae is suspicious for malignant neoplasm.

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Resection of the ovary

After removing the ovary to the wound, it is held by either the operator's hand or by the gauze band around the ovary gates. Wedge-shaped excise tissue of the ovary almost to its gate. Remove 2/3 of the ovary volume. The integrity of it is restored by suturing the absorbent suture material with a round steep needle. The first injection is made with the capture of the bottom of the wound, the second is superficial; when tying the seam edge of the ovary is well compared. You must tie the threads after applying all the stitches. It is possible to sew the ovary with a continuous furrier suture. For the formation of the ovary it is permissible to use biological glue.

The technique of surgery for a tumor or rupture of the ovary: the ovary should be raised, wrap the leg with a wide gauze loop. A line of the cut is just above the level of education or the place of break. On the tangent pathologically altered tissue is removed with a scalpel. The wound of the ovary is sutured with a continuous or nodular catgut suture on a thin round needle.

Technique for the operation of wedge resection of the ovaries in the case of the syndrome of sclerocysts. The ovary stem is covered by a gauze loop. From the ovary tissue on the side facing the abdominal cavity, a wedge-shaped section is located between the poles of the ovary so that after its removal the ovary acquires approximately normal dimensions. The edges of the formed wound are sewn by nodal catgut sutures on a round thin needle. With sclerokistoze ovaries removed at least 2/3 of the tissue of the ovary.

Technique of operation for interconnection of the tumor (enucleatio cystis intralegamentaris): after opening the abdominal cavity and careful orientation in anatomotopographic relationships, the front sheet of the mesosalpinx (wide ligament) dissects between the tube and the uterine ligament. The incision is made on the anterior surface of the tumor in order to avoid injury to the ureter. After the incision with closed scissors, peel off the peritoneum from the tumor capsule. The cyst is gently removed from the inter-connective space, and it should always be kept as close to the tumor capsule as possible. After removal of the cyst, hemostasis is performed and the continuous catgut suture of the wide ligament leaflet is cross-linked in the region of the incision.

Technique for the removal of the ovarian tumor on the leg (ovarioectomia): after laparotomy, the tumor is excised by hand or by a tuppure on the cornzanga placed under the lower pole. Two clamps are placed on the leg of the tumor-one at the rib of the uterus on its own ovarian ligament, the other on the hanging bundle and mesovarium. When removing the tumor with the tube (adnexectomia), the second clamp is superimposed on the funnel-pelvic ligament.

Above the clamps, the foot is crossed and ligated with catgut. Peritonization in the case of removal of the appendages of the uterus is made by a round uterine ligament and a back sheet of a broad ligament. It is possible to superimpose the pouch made through the round ligament, the angle of the uterus and the back of the peritoneum of the broad ligament.

The technique of surgery for torsion of the leg of the ovarian tumor: untwisting of the leg prior to its ligation is dangerous, since there is a risk of rupture of the vessels, the risk of bleeding and thromboembolism. Therefore, without untwisting the stem, the clamp is placed on the entire thickness above the torsion point. The tumor is cut off. The stump is closed with a catgut suture. Peritonization is usually done.

Obstruction of the ovarian cyst

After excretion of the ovary with the tumor into the wound with gauze wipes, it is fenced off from the abdominal cavity. Then a cut (semilunar or circular) is made along the edge of a healthy ovarian tissue with a scalpel so as not to injure the tumor capsule. The edges of the cut are taken to the clamps. Sharp and blunt way to remove the tumor. The sutures are applied in the same way as when resecting the ovary, or first impose submerged, and the second row of sutures form the ovary. It is very important to leave unchanged ovarian tissue, even if there is only a small portion of the cortical layer at the ovary gates.

Removal of the uterine appendages

After removal of the tumor into the wound, clamps are placed on the funnel-hip joint. Before applying the clamps, the fallopian tube and the ovary are raised so that the ligament is stretched and clearly visible in the lumen. Then towards the corner of the uterus, the upper section of the broad ligament is grasped together with the fallopian tube and its own ovary ligament. Ligaments cross, pierce and bandage. Peritonization is performed with the help of a round or broad ligament.

When twisting the legs of the ovarian tumor, the clamp is placed below the torsion point. It is not recommended to untwist the tumor leg, since thrombi, which are usually present in the lumen of twisted vessels, can get into the bloodstream.

Removal of the fallopian tube (salpingoectomy, salpingo seu tubectomia)

Technique: after opening the abdominal cavity in the small pelvis, an arm is inserted, a modified tube is removed, which is removed to the wound. The tube is raised by pulling on its mesentery, on which a clamp is placed from the ampullar end to the corner of the uterus (the clamps should lie parallel to the tube), the second clamp is superimposed to the first. The pipe is cut off over the clamps and sewed by the catgut. Peritonization is performed by a round uterine ligament, which is sewn to the back of the uterus by several catgut sutures, covering the stump of the tube.

Sterilization (sterilisatio chirurgica)

Operation technique for Madeleine: the pipe with a small section of the mesosalpinx is pulled by means of a clamp into the shape of a loop, and the base of the loop is crushed by a clamp. A silk ligature is applied at the clamping point. For greater reliability, the loop is excised.

The technique of the operation according to Genter: the middle part of the tube is pulled upward by two soft clamps, superimposed at a distance of 2-3 cm. The peritone is stretched between the clamps and dissected lengthwise over the tube, which is extracted with a tweezers or a scalpel during the peritoneal incision. The liberated area in the peripheral ends is bandaged with silk ligatures and is removed. Both ends of the crossed pipe are immersed in the mesosalpinx, the wound of which is closed by a continuous catgut suture.

During abdominal trimming, simple tube dressing, crushing of pipes with ligation, splitting of the tube between two ligatures, segmental resection of the tube with processing of the remaining ends, and application of rings to the fallopian tubes can be performed.

Resection of the ovaries (removal of part of the ovary, resectio ovarii)