Currently, innovative technologies have been developed that allow for various gynecological interventions with minimal complications and a low degree of trauma. Removal of the uterus by laparoscopic means is one of them.
Laparoscopy as a new technique
Laparoscopic surgery has been around for over 20 years. And during this time she has established herself as a minimally invasive and effective method with minimal postoperative complications.
Laparoscopic methods in gynecology have gained great popularity. Previously, small volumes were performed in this way. But recently in most clinics and hospitals this has become a common occurrence. One of these operations is the removal of uterine fibroids using the laparoscopic method. Patient reviews indicate that there is a quick recovery of working capacity, the risk of complications and an adhesion process is small, and slight damage to the skin does not spoil the appearance of a woman.
For the operation requires qualified and experienced specialists. The intervention in this case is justified by minimal complications. In some cases, a combination of laparoscopic and traditional surgery is simply necessary to save the patient's life. A real specialist will choose the right method for treating his patients individually in each case.
In many hospitals, uterine fibroids are removed using the laparoscopic method. In Moscow, almost every gynecological department is equipped with the necessary equipment and has specialists to carry out this manipulation. Of all gynecological operations, 50-60% are performed laparoscopically.
The main advantages of the method:
• low degree of trauma;
• rapid restoration of the functions of all organs;
• reduction in postoperative pain;
• minimal adhesion process ;
• short terms of hospitalization;
• stay in a day hospital;
• reduction of the period of disability;
• a minimum of postoperative hernias;
• minimum time for rehabilitation;
• saving drugs.
Negative moments of laparoscopy
All these positive aspects in the process of surgical intervention and recovery of a woman cover all those disadvantages that are inherent in any laparoscopic intervention:
• equipment and training of qualified specialists requires significant material costs;
• the surgeon must be proficient in laparoscopic and traditional surgery;
• complications are a violation of the function of organs associated with the injection of gas into the abdominal cavity, but with the correction and proper prevention of these complications, it can be avoided;
• the possibility of mechanical damage to various organs, tissues and structures is not ruled out.
Application in gynecology
In gynecological practice, laparoscopy is widespread. In addition to diagnosing unclear cases of acute abdomen, finding out the causes of infertility, a laparoscopic technique is used in situations such as:
1. Ectopic pregnancy.
2. Pipe rupture.
3. Surgical sterilization.
4. Endometriosis.
5. Adhesive disease.
6. Various diseases of the ovaries: cysts, sclerocystosis, ovarian apoplexy.
7. Benign uterine tumors (removal of the uterus by the laparoscopic method reduces the risk of postoperative complications).
8. Hyperplastic processes that are not amenable to conservative therapy.
Recently, gynecologists have widely used the removal of the uterus by the laparoscopic method, even with malignant tumors. Now many methods have been developed for this operation, depending on the size of the uterus, its condition and involvement in the process of neighboring organs. This operation is widely used for fibromyomas of various localization.
Uterine Fibromyoma
Uterine fibromyoma is a benign disease in which, under the influence of hormones, fibrous tissue grows with the formation of nodes. A high prevalence of this disease is noted - about 25% of all gynecological problems. Uterine fibroids affect the entire body of a woman. Myomectomy is considered the "gold standard" for the treatment of this disease.
Removal of the uterus by laparoscopic method. Kinds
When choosing a method for surgical treatment of fibroids , many factors are taken into account: the location and size of the nodes, the functionality or damage of neighboring organs, the general condition of a woman. Depending on the defeat of the uterus, appendages, several types of surgical intervention on the reproductive organ are distinguished.
In practice use:
- Total hysterectomy, when the body and cervix are removed; subtotal - the body of the uterus is removed. If the tubes are amputated together with the uterus - hysterubectomy, and if both the tubes and the ovaries, then this operation is called hysterubovariectomy. Radical operations, such as panhisterectomies - removal of all internal genital organs along with lymph nodes, omentum, nearby tissues and part of the vagina, are resorted to in oncological processes.
- With the small size of the nodes and to preserve the childbearing function, a woman performs organ-preserving operations. One of these is the removal of subserous uterine fibroids by the laparoscopic method. With a slight lesion of the uterus, enucleation of nodes is performed, that is, husking of fibrous tissue with subsequent preservation of the organ. After such operations, a woman may become pregnant and give birth after some time.
Contraindications
There are contraindications for the operation of the removal of uterine fibroids by the laparoscopic method. Reviews of gynecologists indicate that in most cases the operation can be performed by everyone, except for those women who suffer from severe forms of cardiovascular, respiratory failure, have hernias, problems with the blood coagulation system or general exhaustion of the body
Relative contraindications are conditions in which the operation is possible, but it is associated with some difficulties. It:
• significantly expressed subcutaneous fat;
• untreated infectious diseases;
• adhesive process;
• effusion or the presence of fluid in the abdominal cavity of more than 1 liter.
But modern gynecologists, possessing the technique of laparoscopic operations, after further examination for such diseases prescribe a course of treatment, sanitize the foci of infection and carry out surgical intervention. In this case, all the pros and cons are weighed before conducting a laparoscopic operation.
Preparation for surgery
From the reviews of women who underwent the removal of the uterus by the laparoscopic method, it is known that patients are unhappy only with the preparation: the operation lasts 40 minutes, and the preparation lasts 2 weeks or more.
A woman should come for an operation after tests are completed and the results are obtained:
• blood tests (general, biochemical, for blood type and Rh factor, for hepatitis, syphilis and HIV, for coagulability, glucose determination);
• urine tests - general and for the determination of sugar;
• smears;
• electrocardiograms;
• fluorography;
• ultrasound;
• colposcopy;
• examination of specialists: therapist, if necessary, cardiologist, etc.
Before surgery for patients with uterine myoma, a separate diagnostic curettage of the uterus and obtaining histological results are required. This is necessary to resolve the issue of the volume of surgical intervention and to exclude and prevent the further development of cancer processes.
All examinations are a necessary procedure, and only after a full examination the surgeon will be able to remove the uterus using the laparoscopic method.
The day before the operation, it is not recommended to eat food, it is necessary to shave the pubic hair.
Before the operation, the woman fills out the consent form for anesthesia and separately for the operation. If necessary, medication or psychoprophylactic preparation for surgery is performed.
Operation Technique
The operation to remove the uterus by the laparoscopic method is performed for fibroids up to 16 weeks of gestation, which are complicated by bleeding, are characterized by rapid growth or the risk of malignant transformation. Although some experienced specialists completely remove the uterus, the size of which is about 20 weeks. But most often, given the woman’s age, they remove the uterine fibroids using the laparoscopic method, leaving a small part of the uterus for menstruation.
Three or four punctures of the abdominal wall are used (one near the navel, the other two on the sides) and trocars are inserted. It is a device equipped with a monitoring chamber or light installation with a carbon dioxide or nitrous oxide supercharger and tools.
After examination, uterine fibroids are removed using the laparoscopic method. For this, ligaments are excised, vessels are ligated, the uterus is cut off from the walls of the vagina and removed through the vagina through incisions in the arches. This operation is called laparoscopically assisted vaginal myomectomy. Sewing of incisions into the vagina is performed. It is possible to delete several nodes in one operation without repeated intervention.
At the end, the blood or fluid accumulated during the operation is diluted, the organs and walls of the abdominal cavity are examined again. They carefully check whether the vessels are well bandaged and ligated, and there is no sweating of blood or lymphatic fluid. Eliminate gas and remove tools. Then there is a suturing of the skin and subcutaneous tissue at the sites of introduction of the trocars, the skin is sutured with cosmetic sutures.
The duration of the operation can be from 15 minutes to 1.5 hours, depending on the amount of surgical intervention performed.
Anesthesia for an operation such as removal of the uterus by the laparoscopic method: reviews
Which anesthesia is better? This issue should be decided by the surgeon together with the anesthetist, taking into account the general condition of the patient, indicators of laboratory tests, and the estimated scope of the operation. In most cases, endotracheal combined anesthesia is used. Reviews of women say that it is well tolerated, there are no headaches. A woman will be awakened 15-20 minutes after an operation such as removal of the uterus by the laparoscopic method.
The postoperative period with proper anesthesia leads to good results after the intervention: the pain does not bother, there is only slight discomfort, which disappears after 2 days. Sometimes there may be nausea, but this is stopped by Metoclopramide. The first day you can drink only water. By evening, you can already rise and get up. On the second day, you can take food that does not irritate the intestines: cereals, broths, dairy products. The discharge is carried out on the second day after the intervention, and the sick leave is closed after 30 days. After that, a woman can safely go to work, but with the restriction of heavy physical labor for a month. Sutures are removed on the 5th postoperative day.
After surgery, complications are rare, which are rare: trauma to the internal organs by a trocar, bleeding from insufficiently ligated vessels, and subcutaneous emphysema. All this can be prevented if you strictly observe the technique of surgery and carefully conduct an audit of the abdominal cavity.
Effects
It should be noted that after an operation such as removal of the uterus by the laparoscopic method, the consequences are usually minimal. Recovery occurs after 2 weeks of rehabilitation. 30 days after surgery, a woman can do her usual business. Feasible exercise is recommended. But even after a month, it is undesirable to load the abdominal muscles, lift weights, and be in the sun.
In the early days, minor pulling pains in the lower abdomen are possible. This is normal and should go away in 1-2 days. The formation of an adhesive process is possible, but according to statistics this happens extremely rarely and only with a genetic predisposition of the body or with severe endometriosis.
Minor discharge from the genital tract is possible. This is normal if the ovaries are preserved. They continue to produce hormones that trigger this reaction.
Cases of inflammatory processes after laparoscopic surgery are rare, because antibiotic therapy is prescribed immediately after the intervention and lasts for 5 days. At the same time, the water-electrolyte composition of the blood is corrected.
The patient's fertility is restored almost immediately, and in some cases there is even an increase in libido. A woman can live sexually 1 month after surgery. If the organ is preserved, you can become pregnant six months after the intervention.
Where can I have an operation?
Many hospitals may offer laparoscopic removal of the uterus. In Moscow, city hospitals that are equipped with equipment and have specialists who know this technique will offer you these services. The price of the operation is negotiated with the attending physician.
The examination can be carried out in the department itself or previously in the hospital in the community. For such operations, a quota may be issued. The cost of laparoscopic removal of the uterus is approximately 45 to 70 thousand.