Vaginal extirpation of the uterus

Vaginal extirpation of the uterus can be simple and rather complicated if it is produced without lowering the walls of the vagina and in the absence of failure of the muscles of the pelvic floor. Post-operative course after vaginal operation, as a rule, is easier than with abdominal cavity.

For carrying out vaginal extirpation of the uterus, there are the following contraindications:

1. the size of the uterus tumor corresponding to pregnancy is more than 2 weeks;
2. repeated intubation in those cases when a significant adhesion process in the abdominal cavity can be expected;
3. need for revision of the abdominal cavity;
4. combined pathology, ie, the presence, in addition to the tumor of the uterus, also a large ovarian tumor.

After the appropriate treatment, a mirror and a lift are inserted into the vagina. The cervix is grasped with denticles in such a way that the front and back lips of the uterus immediately fall into the clamp. Then the spoon-shaped mirror is replaced with a mirror of the Doyen type. In the vagina introduce lateral lifts.

Produce a circular incision of the vagina on the border of its transition to the cervix and separate it up in a blunt and acute way. Place the clamps on the cardinal ligaments, cross and ligate. Ligatures are taken on the holders. After crossing the cardinal ligament the uterus becomes more supple. Pulling it down the neck, produce an excision of the bladder right up to the vesicle-uterine fold. The autopsy of the posterior vaginal vault is performed. Once the posterior vaginal foramen is opened, with constant tension of the uterus, the tissues directly intersect sequentially to the lateral surfaces of the uterus and gradually the uterus is removed from the abdominal cavity. After sufficient mobility is achieved, the uterus is opened with a vesicle-uterine fold, the seam is applied and taken on the holder. The uterus is seized with bullet forceps and dislocated into the wound, after which the round ligament of the uterus, its own ligament of the ovaries and the fallopian tubes become available. They are clamped, crossed and ligated. When pulling the uterus to itself and downwards, clamps are placed on the uterine vessels. Vessels cross and ligate. The uterus is removed.

If it is necessary to remove the appendages of the uterus, long mirrors are inserted into the abdominal cavity. At the same time, the funnel-and-pelvic ligaments become accessible, on which the clamps are applied. Ligaments cross and ligate. Ligatures are taken on the clamps.

After removal of the uterus, the wound is sutured in such a way that the stumps of the ligaments remain outside the peritoneum. To do this, the first suture is applied to the left in such a way that the needle passes through the vaginal wall, the peritoneal sheet, the ligament stump and the vascular bundle, the peritoneum of the rectum and uterine cavity and the back wall of the vagina. Then, only the walls of the vagina are seized by the same suture. The thread should not be tied, so as not to obstruct the suture from the other side. After the threads are stretched from both sides, knots should be tied. When properly sealed, the walls of the vagina are joined. Cult of ligaments remain between the leaflets of the peritoneum and the wall of the vagina, i.e., reliably peritonized. If necessary, you can impose an additional seam on the wall of the vagina. It is not necessary to achieve complete tightness of the abdominal cavity, since if there is a wound detachable, it is excreted outward.