Currently, innovative technologies have been developed that allow various gynecological interventions to be performed with minimal complications and a low degree of trauma. Laparoscopic hysterectomy is one of them.
Laparoscopy as a new technique
Laparoscopic surgery has been around for over 20 years. And during this time it has established itself as a minimally invasive and effective method with minimal postoperative complications.
Laparoscopic methods in gynecology have gained great popularity. Previously, gynecological operations of small volumes were performed in this way. But recently in most clinics and hospitals it has become commonplace. One of these operations is the removal of uterine fibroids by laparoscopic method. Patients' reviews indicate that there is a rapid recovery of working capacity, the risk of complications and adhesionssmall, and a slight damage to the skin does not spoil the appearance of a woman.
Skilled and experienced professionals are required for the operation. Intervention in this case is justified by minimal complications. In some cases, a combination of laparoscopic and conventional surgery is simply necessary to save the patient's life. A real specialist will select the right method for treating his patients in each case individually.
Many medical institutions carry out the removal of uterine fibroids by 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 surgeries, 50-60% are performed laparoscopically.
Main advantages of the method:
• low degree of injury;
• rapid recovery of the functions of all organs;
• reduction of postoperative pain;
• minimal adhesive process;
• short hospital stays;
• day hospital stay;
• reduction of disability periods;
• minimum incisional hernias;
• minimum recovery time;
• saves on medicines.
Negative moments of laparoscopy
All these positive aspects in the process of surgery and recovery of a woman cover all the shortcomings that are characteristic of any laparoscopic intervention:
• equipment andtraining of qualified specialists requires significant material costs;
• The surgeon must be proficient in both laparoscopic and conventional surgery;
• complications are in violation of the function of organs associated with the injection of gas into the abdominal cavity, but with correction and proper prevention of these complications can be avoided;
• the possibility of mechanical damage to various organs, tissues and structures is not excluded.
Use in gynecology
In gynecological practice, laparoscopy has become widespread. In addition to diagnosing unclear cases of acute abdomen, finding out the causes of infertility, the laparoscopic technique is used in situations such as:
1. Ectopic pregnancy.
2. Pipe burst.
3. Surgical sterilization.
4. Endometriosis.
5. Adhesive disease.
6. Various ovarian diseases: cysts, sclerocystosis, ovarian apoplexy.
7. Benign uterine masses (removal of the uterus by 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 laparoscopic method, even with malignant tumors. Now many techniques have been developed for this operation, depending on the size of the uterus, its condition and the involvement of neighboring organs in the process. This operation is widely used for fibromyomas of various localization.
Uterine fibroids
Uterine fibromyoma is a benign disease in which, under the influence of hormones, fibrous tissue grows with the formation of nodes. There is a high prevalence of this disease - about 25% of all gynecological problems. Uterine fibroids affect the entire body of a woman. Myomectomy is considered the "gold standard" treatment for this condition.
Removal of the uterus by laparoscopic method. Species
When choosing a method of surgical treatment of fibroids, many factors are taken into account: the location and size of the nodes, the functionality or damage to neighboring organs, the general condition of the woman. Depending on the damage to the uterus, appendages, there are several types of surgical intervention on the reproductive organ.
Used in practice:
- Total hysterectomy, when both the body and the cervix are removed; subtotal - the body of the uterus is removed. If the tubes are amputated along with the uterus - hystertubectomy, and if both the tubes and the ovaries, then this operation is called hystertubovaryectomy. Radical operations, such as panhysterectomy - 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 small nodes and to preserve the childbearing function, a woman undergoes 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 is performednodes, that is, husking of fibrous tissue with subsequent preservation of the organ. After such operations, a woman can become pregnant and give birth after some time.
Contraindications
There are contraindications to the operation of removing uterine fibroids by laparoscopic method. Reviews of gynecologists indicate that in most cases the operation can be performed by everyone, with the exception of 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 an operation is possible, but this is associated with some difficulties. This is:
• significantly pronounced subcutaneous fat;
• untreated infectious diseases;
• adhesive process;
• Abdominal effusion or more than 1 liter of fluid in the abdomen.
But modern gynecologists, having the technique of laparoscopic operations, after additional examination for such diseases prescribe a course of treatment, sanitize the foci of infection and perform surgery. In this case, all the pros and cons are weighed before performing a laparoscopic operation.
Preparation for surgery
From the reviews of women who underwent laparoscopic hysterectomy, it is known that patients are dissatisfied only with the preparation: the operationlasts 40 minutes, and the preparation is 2 weeks or more.
A woman should come to the operation after the tests are passed and the results are received:
• blood tests (general, biochemical, blood type and Rh factor, hepatitis, syphilis and HIV, clotting, glucose determination);
• urine tests - general and sugar;
• brush strokes;
• electrocardiogram;
• Fluorography;
• Ultrasound;
• colposcopy;
• examination by specialists: a therapist, if necessary, a cardiologist, etc.
Before surgery, patients with uterine fibroids require separate diagnostic curettage of the uterus and histological results. This is necessary to resolve the issue of the scope of surgical intervention and exclude and prevent further development of oncological processes.
All examinations are a necessary procedure, and only after a complete examination, the surgeon will be able to perform the removal of the uterus by laparoscopic method.
Food is not recommended the day before surgery, pubic hair must be shaved.
Before the operation, a woman fills out a consent form for anesthesia and separately for the operation. If necessary, medical or psychoprophylactic preparation for surgical intervention is carried out.
Surgery technique
The operation to remove the uterus by laparoscopic method is performed for fibroids up to 16 weeks of pregnancy, which are complicated by bleeding, are characterized by rapid growth or dangermalignant transformation. Although some experienced specialists completely remove the uterus, the size of which is about 20 weeks. But most often, given the age of the woman, the removal of uterine fibroids is carried out by 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 are on the sides) and trocars are inserted. This is a device equipped with a monitoring camera or light set with a carbon dioxide or nitrous oxide blower and tools.
After the examination, the removal of uterine fibroids is carried out by the laparoscopic method. To do this, the ligaments are excised, the vessels are ligated, the uterus is cut off from the walls of the vagina and removed through the vagina through incisions in the vaults. This operation is called laparoscopically assisted vaginal myomectomy. The incisions in the vagina are sutured. It is possible to remove several nodes in one operation without repeated intervention.
At the end, they remove the blood or fluid accumulated during the operation, once again examine the organs and walls of the abdominal cavity. Carefully check if the vessels are well tied and ligated, if there is any leakage of blood or lymphatic fluid. Eliminate the gas and withdraw the instruments. Then the skin and subcutaneous tissue are sutured at the trocar insertion sites, 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 surgery performed.
Pain relief for an operation such as laparoscopic hysterectomy: reviews
Which anesthesia is better? This issue should be decided by the surgeon together with the anesthesiologist, taking into account the general condition of the patient, laboratory tests, and the expected 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 is awakened 15-20 minutes after an operation such as laparoscopic hysterectomy.
The postoperative period with proper anesthesia leads to good results after the intervention: 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 get up and get up. On the second day, you can eat food that does not irritate the intestines: cereals, broths, dairy products. The extract 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. The sutures are removed on the 5th postoperative day.
After the operation, complications are possible, which are rare: trauma to the internal organs by the trocar, bleeding from insufficiently ligated vessels, subcutaneous emphysema. All this can be prevented if the technique is strictly observed.surgery and carefully examine the abdominal cavity.
Consequences
It should be noted that after an operation such as removal of the uterus by laparoscopic method, the consequences are usually minimal. Recovery occurs after 2 weeks of rehabilitation. 30 days after the operation, the woman can go about her usual activities. Strong physical exercise is recommended. But even after a month it is undesirable to load the abdominal muscles, lift weights, be in the sun.
In the first days, slight 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 occurs extremely rarely and only with the genetic predisposition of the body or with severe endometriosis.
Possible slight discharge from the genital tract. This is normal if the ovaries are preserved. They continue to produce hormones that cause this reaction.
Inflammatory processes after laparoscopic operations are rare, because antibiotic therapy is prescribed immediately after the intervention and continues for 5 days. At the same time, the water and 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 the operation. If the organ is preserved, you can become pregnant six months after the intervention.
Where you can spendoperation?
Many hospitals can offer laparoscopic hysterectomy. In Moscow, city hospitals that are equipped with equipment and have specialists who own this technique will offer you these services. The price of the operation is negotiated with the attending physician.
Examination can be carried out in the department itself or previously in the hospital at the place of residence. For such operations, it is possible to issue a quota. The cost of laparoscopic removal of the uterus is approximately 45 to 70 thousand.
