The increase in the age of patients planning pregnancy inevitably leads to an increase in many pathological conditions of the reproductive system, which subsequently requires reconstructive surgery. The conditions of modern society dictate higher requirements to the surgical interventions, namely: high efficiency, quality and safety that leads to search for additional techniques in operative gynecology.
THE PURPOSE OF THE STUDY
To study application of the blood-saving technologies at the laparoscopic and laparotomy accesses in the operative gynecology as the techniques improving quality of the operative aid at the organ-preserving operations.
MATERIAL AND METHODS
Two clinical observations devoted to the blood-saving techniques application both in operations carried out by the laparotomy access and at the laparoscopy operations in operative gynecology are presented. Use of the turnstile clamp as well as temporary clipping of the uterine arteries and funnel ligament vessels during the reconstructive plastic surgeries on the uterus was shown to decrease the volume of the intraoperative blood loss.
RESULTS
The use of the turnstile clamp at the level of the internal os applied at the laparotomy access in patients with the uterine scar and the presence of a deep niche and expressed hematoma in the scar projection after cesarean section permitted to demonstrate its effectiveness in decreasing the risk of the profuse bleeding and provided the performance of the reconstructive-plastic uterine operation. Temporary clipping of the ascending uterine artery branch and the funnel ligament vessels on both sides resulted in high efficacy, convenience of performing for the operating team, decrease of intraoperative blood loss and improvement of the quality of laparoscopic myomectomy in patients with large-size uterine myoma.
CONCLUSION
Application of the hemostatic tourniquet in the laparotomy access and clipping of the ascending uterine artery branch and the funnel sac vessels in laparoscopic myomectomy essentially facilitate the operation, decrease the risk of intraoperative complications, improve the efficacy and quality of the operative aid; this ensures high accuracy of the intervention, maximal conservation of the surrounding healthy tissue and allows one to safely perform reconstructive-plastic operations in patients with myoma.
