Abstract:
An improved method for performing a hysterectomy wherein the cardinal ligaments and the uterosacral ligaments attached to a uterus are not severed. Also, the wall of the vaginal apex is not cut. This is accomplished by coring through the cervical stroma of the uterus close to the wall of the endocervical canal and transformation zone and removing the endocervical canal and transformation zone from the cervical stroma. The opening left in the cervical stroma after removal of the endocervical canal and transformation zone is closed with sutures. This technique is practically bloodless. The nerve plexuses and the support system of the female internal organs are preserved. The chance of future cervical cancer is substantially eliminated. This is truly a technique for the 21 st  century.

Description:
DESCRIPTION  
         [0001]    1. Technical Field  
           [0002]    This invention relates to surgical methods for performing hysterectomies on female patients.  
           [0003]    2. Background of the Invention  
           [0004]    A hysterectomy involves the removal of the uterus from the abdomen of a female patient. The traditional method of performing a hysterectomy is to sever the uterosacral ligaments, the cardinal ligaments and the uterine vessels attached to the uterus before entering the vaginal fornix. The uterus is then severed from the vagina in a circular fashion at the cervico-vaginal junction. To access this area, the bladder is pushed down and, if necessary, dissected free of any attachments to the uterus.  
           [0005]    This traditional procedure causes significant damage to the nerves in the Frankenhauser nerve plexus, the vesical nerve plexus and various regional nerves such as the nerves to the clitoris, the urethra and the vestibular bulbs. This traditional procedure also causes a major impairment of the pelvic support system for the vagina and other major complications.  
         SUMMARY OF THE INVENTION  
         [0006]    The present invention provides an improved surgical method of hysterectomy for removing a uterus including its endocervical canal and transformation zone in a manner which preserves important nerve entities and pelvic support structures while, at the same time, reducing the risk of cervical cancer. This improved method includes coring through the cervical stroma of a uterus close to the wall of the endocervical canal and transformation zone so as to leave the bulk of the cervical stroma in tact and connected to the cardinal ligaments, the uterosacral ligaments and the wall of the vaginal apex. The endocervical canal and transformation zone are removed from the cervical stroma and the opening left in the cervical stroma by the removal of the endocervical canal and transformation zone is closed with sutures. This new technique is a relatively bloodless technique.  
           [0007]    For a better understanding of the present invention, together with other and further advantages and features thereof, reference is made to the following description taken in connection with the accompanying drawings, the scope of the invention being pointed out in the appended claims. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0008]    Referring to the drawings:  
         [0009]    [0009]FIG. 1 is a longitudinal cross-sectional view of a human female uterus;  
         [0010]    [0010]FIG. 2 is a transverse cross-sectional view of the FIG. 1 uterus taken along section line  2 - 2  of FIG. 1;  
         [0011]    [0011]FIG. 3 is a transverse cross-sectional view of the FIG. 1 uterus taken along section line  3 - 3  of FIG. 1;  
         [0012]    [0012]FIG. 4 is longitudinal cross-sectional view of the portion of the FIG. 1 uterus that is removed from the abdomen of the patient;  
         [0013]    [0013]FIG. 5 is a perspective view showing the portion of the cervix that remains in the body of the patient after removal of the portion of the uterus shown in FIG. 4; and  
         [0014]    [0014]FIG. 6 is a perspective view of the cervix portion of FIG. 5 after closure with sutures of the opening left in the cervix by removal of the endocervical canal and transformation zone. 
     
    
     DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENT  
       [0015]    Referring to FIG. 1 of the drawings, there is shown a longitudinal cross-sectional view of a human female uterus  10 . The upper portion  11  of uterus  10  is called the corpus and the lower portion  12  is called the cervix. A typical uterus in a non-pregnant adult female human being is approximately three inches in length and has a width of approximately two inches at its widest. The diameter of the cervix  12  is a little less than one inch along section line  2 - 2 . The larger cavity  13  in the upper region of uterus  10  is called the endometrial cavity. A tubular passageway  14 , called the endocervical canal, runs from the lower end of endometrial cavity  13  to the top end or apex of a vagina  15 . Cervix  12  extends a short distance into the vagina  15 , the upper end of vagina  15  being attached to and closed by the lower portion of cervix  12 . An outwardly flaring portion  16  at the lower end of the endocervical canal  14  is called the transformation zone or T-zone. The fibrous tissue  17  forming the interior of the cervix  12  and surrounding the endocervical canal  14  is called cervical stroma.  
         [0016]    As an example of a problem, the roundish blotches  18  shown on uterus  10  are fibroid tumors which sometimes form on the wall of a uterus. Sometimes, such as in the case of fibroid  19 , they extend outwardly a noticeable distance from the uterus. For present purposes, it is assumed that some of the fibroids on uterus  10  are harmful and that this is the reason for removing the uterus  10 .  
         [0017]    Attached to the upper sides of uterus  10  are a pair of Fallopian tubes  20  which extend to different ones of the two ovaries (not shown). It is through one of the Fallopian tubes  20  that the egg enters the interior of the uterus  10 . Attached to the wall of uterus  10  near the upper end thereof are ovarian ligaments  27  and round ligaments  28 . Closer to cervix  12  are two uterine arteries  21  and  22 . A short distance downwardly are two sets of cardinal ligaments  23  and  24  which are attached to the two sides of the cervix  12 . These ligaments extend outwardly and their far ends are attached to the pelvic wall (not shown). Cardinal ligaments  23  and  24  provide a significant amount of support for uterus  10 . Immediately below the cardinal ligaments are two sets of uterosacral ligaments  25  and  26  which are attached to the two sides of cervix  12  and extend outwardly to and are attached to the pelvic wall (not shown).  
         [0018]    [0018]FIGS. 2 and 3 are transverse cross-sections of cervix  12  of FIG. 1, taken along section lines  2 - 2  and  3 - 3 , respectively. Among other things, these figures show the circular natures of cervix  12  and endocervical canal  14 .  
         [0019]    The present invention provides an improved surgical method for removing a uterus with reduced trauma to the patient and fewer postoperative problems. It is, of course, necessary to make various cuts and incisions in order to free the uterus from the body of the patient. The lines along which cuts are made are indicated by the broken lines in FIGS.  1 - 3 . As seen in FIG. 1, the Fallopian tubes  20  and ovarian ligaments  27  are severed, as indicated at  30  and  31 . Round ligaments  28  are severed. The uterine arteries  21  and  22  are clamped and their ends are cut out of the cervix  12 , as indicated by cut lines  32  and  33 .  
         [0020]    Next comes the severing of the uterus  10  from the vagina  15 . The present invention does this in a special way. In particular, a circular incision  34  is made into the cervical stroma  17  close to the wall of the endocervical canal  14  and transformation zone  16  so as to form a severed core which includes the endocervical canal  14  and transformation zone  16 . The circular nature of this incision  34  is seen in FIGS. 2 and 3. This incision  34  extends from the lower end of cervix  12  upwardly to a level a short distance above the cardinal ligaments  23  and  24 . A lateral incision  35  is made into the side of the cervix  12  to a depth sufficient to join with the longitudinal coring incision  34 . Lateral incision  35  is made completely around the cervix  12  so as to separate the upper portion  17   a  of cervical stroma  17  from the lower portion  17   b  of cervical stroma  17 .  
         [0021]    [0021]FIG. 4 shows the severed uterus  10  after removal from the body of the patient. The results of coring incision  34  and lateral incision  35  are clearly seen in FIG. 4. As shown, the endocervical canal  14  and transformation zone  16  are included with the part of the uterus  10  which is removed.  
         [0022]    [0022]FIG. 5 shows the portion of cervix  12  that remains in the body of the patient. It is a doughnut shaped structure that remains attached to the cardinal ligaments  23 , 24 , the uterosacral ligaments  25 , 26  and the wall of the apex or fornix of vagina  15 . Thus, the procedure of the present invention leaves in tact the bulk of the lower portion  17   b  of cervical stroma  17 .  
         [0023]    [0023]FIG. 6 shows the cervix portion of FIG. 5 after closure with sutures of the opening or passageway  34  left in the cervix  12  by removal of the core portion containing the endocervical canal  14  and transformation zone  16 . As seen in FIG. 5, a first suture  40  is circumferentially attached to the lower end of cervix  12  so as to encircle the lower opening of cervix  12 . This is accomplished by weaving suture  40  in and out of the outer wall of cervix  12 . This is preferably done before the coring incision  34  is made, the free ends of suture  40  being left untied. After completion of the coring procedure and after removal of the core containing endocervical canal  14  and transformation zone  16 , the free ends of suture  40  are pulled tight so as to force a closure of the lower opening in cervix  12 . The ends of suture  40  are then tied together to make the closure permanent.  
         [0024]    A second suture  42  is used to close the upper opening in the cervical stroma portion  17   b.  Sutures  40  and  42  are preferably of the delayed absorption type. After a short period of time, the squeezed together wall portions of passageway  34  will be permanently interconnected by fibrous tissue growth.  
         [0025]    As seen in FIGS. 1 and 3, the core formed by coring incision  34  has a slight conical shape to it, the diameter of the core becoming smaller as one moves in the upward direction. As mentioned, the coring incision  34  is made close to the wall of the endocervical canal  14  and transformation zone  16  so as to leave the bulk of lower cervical stroma portion  17   b  in tact. The lateral distance between the upper end of core incision  34  and the wall of endocervical canal  14  is typically about one-quarter of an inch. Incision  34  runs downwardly pretty much in a straight line to the bottom of cervix  12  at a point about one-quarter of an inch laterally of the mouth of transformation zone  16 .  
         [0026]    Core incision  34  may be made in either the downward or the upward direction. In the downward case, the lateral incision  35  is made, after which the cutting instrument is turned in the downward direction to make core incision  34 . In the upward case, the cutting instrument is inserted into the vagina  15  and moved in the upward direction to make core incision  34 . The cutting instrument may be, for example, either an electrosurgical Bovie knife or, alternatively, a laser knife.  
         [0027]    With the method of the present invention, neither the cardinal ligaments nor the uterosacral ligaments are severed. This avoids injury to the Frankenhauser nerve plexus and to the vesical nerve plexus, as well as injury to other nerves such as nerves to the clitoris, urethra and vestibular bulbs. The present invention also preserves the pelvic support system for the vagina. This minimizes postoperative problems related to bladder dysfunction, as well as possible vaginal sexual dysfunction. Furthermore, removal of the endocervical canal and transformation zone greatly reduces the risk of developing a cervical cancer. At the same time, applicant&#39;s technique is one of the best bloodless techniques of modern medicine.  
         [0028]    While there has been described what is at present considered to be a preferred embodiment of this invention, it will be obvious to those skilled in the art that various changes and modifications may be made therein without departing from the invention and it is, therefore, intended to cover all such changes and modifications as come within the true spirit and scope of the invention.