Controversial issues of work with uterine tissues in laparoscopic myomectomy

Plekhanov A.N.; Bezhenar’ V.F.; Shishkina Yu.S.; Linde V.A.; Vysotsky M.M.

doi:https://doi.org/10.17116/endoskop20222804135

Plekhanov A.N.

Pavlov First St. Petersburg State Medical University;
St. Petersburg Clinical Hospital of the Russian Academy of Sciences

ORCID: 0000-0002-5876-6119

Bezhenar’ V.F.

Pavlov First St. Petersburg State Medical University

ORCID: 0000-0002-7807-4929

Shishkina Yu.S.

MEDI PROF LLC

ORCID: 0000-0001-9502-298X

Linde V.A.

Pavlov First St. Petersburg State Medical University

ORCID: 0000-0002-6032-1936

Vysotsky M.M.

Evdokimov Moscow State University of Medicine and Dentistry

ORCID: 0000-0003-1055-0068

Controversial issues of work with uterine tissues in laparoscopic myomectomy

Authors:

Plekhanov A.N., Bezhenar’ V.F., Shishkina Yu.S., Linde V.A., Vysotsky M.M.

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Journal: Endoscopic Surgery. 2022;28(4): 35‑41

DOI: 10.17116/endoskop20222804135

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To cite this article:

Plekhanov AN, Bezhenar’ VF, Shishkina YuS, Linde VA, Vysotsky MM. Controversial issues of work with uterine tissues in laparoscopic myomectomy. Endoscopic Surgery. 2022;28(4):35‑41. (In Russ.)
https://doi.org/10.17116/endoskop20222804135

Подписка 2026 Эндоскопическая хирургия (Endoscopic Surgery)

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OBJECTIVE

To compare the state of the myometrium and pseudocapsule in the projection of myomatous nodes after dissection with instruments with ultrasonic energy different in initial characteristics and to compare the effectiveness of a double-row continuous suture on the uterus and a multi-row suture.

MATERIAL AND METHODS

A non-randomized study of the state of the myometrium and pseudocapsule in the projection of the myomatous node after dissection using ultrasound energy with different initial characteristics and an assessment of the effectiveness of a double-row continuous suture on the uterus in comparison with a multi-row one was carried out.

The design of the work was built in the form of a prospective controlled study that included 36 patients selected based on the examination criteria for surgical treatment during hospitalization in the gynecological department.

RESULTS

According to our study, the depth of the defect was minimal when exposed to ultrasound with the following characteristics: longitudinal feed, output frequency 47 kHz and intermittent operation mode 5/10 s. The zone of irreversible changes is minimal when exposed to ultrasound with output characteristics: transverse feed at an angle of 90° to the blade, intermittent operation mode on/off 3/30 s, output frequency 36 kHz. The maximum zone of irreversible changes was formed after exposure to ultrasound with output characteristics: longitudinal feed, frequency 47 kHz, periodic operation mode 5/10 s. A significant decrease in the duration of surgery and intraoperative blood loss indicates that, in the presence of a self-fixing thread, the application of a double-row continuous suture to the uterine wound after enucleation of the myomatous node is preferable.

CONCLUSION

When dissecting tissues in the area of the myomatous node, the transverse delivery of ultrasonic energy at an angle of 90° to the blade is preferable to the longitudinal delivery of ultrasonic energy to the tip of the instrument. The use of a double-row continuous suture on the uterus significantly reduces the duration of surgery and intraoperative blood loss.

Keywords:

laparoscopic myomectomy

dissection

ultrasound energy

morphometry

suturing of the myoma bed

Authors:

Plekhanov A.N.

Pavlov First St. Petersburg State Medical University;
St. Petersburg Clinical Hospital of the Russian Academy of Sciences

ORCID: 0000-0002-5876-6119

Bezhenar’ V.F.

Pavlov First St. Petersburg State Medical University

ORCID: 0000-0002-7807-4929

Shishkina Yu.S.

MEDI PROF LLC

ORCID: 0000-0001-9502-298X

Linde V.A.

Pavlov First St. Petersburg State Medical University

ORCID: 0000-0002-6032-1936

Vysotsky M.M.

Evdokimov Moscow State University of Medicine and Dentistry

ORCID: 0000-0003-1055-0068

Received:

03.02.2022

Accepted:

18.03.2022

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