Laparoscopic removal of the uterus: postoperative period, consequences, reviews. Removal of uterine myoma by laparoscopic method: reviews

Currently, innovative technologies have been developed that allow for various gynecological interventions with minimal complications and a low degree of trauma. Laparoscopic removal of the uterus is one of them.

Laparoscopy as a new technique

Laparoscopic surgery has been around for more than 20 years. And during this time it has proved to be a minimally invasive and effective method with minimal postoperative complications.

Laparoscopic methods in gynecology have gained great popularity. Earlier, gynecological operations of 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 by a laparoscopic method. The patients' testimonies testify that there is a rapid restoration of the operability, the risk of complications and adhesions is small, and a slight damage to the skin does not spoil the appearance of the woman.

The operation requires qualified and experienced specialists. Intervention in this case is justified by minimal complications. In some cases, the combination of laparoscopic and traditional surgery is simply necessary to save the patient's life. This specialist will select the right method for treating his patients in each case individually.

In many medical institutions, uterine fibroids are removed 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 operations, 50-60% are performed by laparoscopic way.

The main advantages of the method:

• low degree of traumatism;

• rapid restoration of the functions of all organs;

• reduction of postoperative pain;

• minimal adhesion process ;

• short periods of hospitalization;

• stay in the day hospital;

• reduction of the period of incapacity for work;

• a minimum of postoperative hernias;

• minimum time for rehabilitation;

• saving medicines.

Negative aspects of laparoscopy

All these positive moments in the process of surgical intervention and recovery of a woman cover all those shortcomings that are peculiar to any laparoscopic intervention:

• equipment and training of qualified specialists requires significant material costs;

• The surgeon must be proficient in the methods of laparoscopic and traditional surgery;

• complications are a violation of the function of organs associated with the injection into the abdominal cavity of gas, 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 ruled out.

Application in gynecology

In gynecological practice, laparoscopy has become widespread. In addition to diagnosis in cases of unclear cases of an acute abdomen, finding out the causes of infertility, laparoscopic technique is used in such situations as:

1. Ectopic pregnancy.

2. Rupture of the pipe.

3. Surgical sterilization.

4. Endometriosis.

5. Adhesive disease.

6. Various diseases of the ovaries: cysts, sclerocystosis, ovarian apoplexy.

7. Benign uterine formations (removal of the uterus by laparoscopic method reduces the risk of postoperative complications).

8. Hyperplastic processes, not amenable to conservative therapy.

Recently, gynecologists have widely used laparoscopic removal of the uterus even in 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 fibroids of different localization.

Fibromyoma of the uterus

Fibromioma of the uterus is a benign disease in which under the influence of hormones there is a proliferation of fibrous tissue with the formation of nodes. There is a large prevalence of this disease - about 25% of all gynecological problems. Myoma of the uterus affects the entire body of a woman. Myomectomy is considered the "gold standard" for the treatment of this disease.

Laparoscopic removal of the uterus. Kinds

When choosing the method of operative 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 the woman. Depending on the defeat of the uterus, appendages distinguish several types of operative intervention on the reproductive organ.

In practice, they use:

- Total hysterectomy, when both the body and the cervix are removed; Subtotal - the body of the uterus is removed. If, together with the uterus, the tubes are amputated - hystertubectomy, and if both the tubes and the pits, then this operation is called hystertubovarioctomy. To radical operations, such as pangysterectomy - removal of all internal genital organs together with lymph nodes, omentum, nearby tissues and part of the vagina, resort to oncological processes.

- At small sizes of knots and for preservation of genital function to the woman organ-saving operations are carried out. One of these is the removal of the subserous uterine myoma by a laparoscopic method. With a slight lesion of the uterus, the enucleation of the nodes is performed, that is, the exfoliation of the fibrous tissue with subsequent preservation of the organ. After such operations, a woman can become pregnant and give birth after a while.

Contraindications

There are contraindications to the operation of removing uterine fibroids by laparoscopic method. Reviews of gynecologists suggest that in most cases the operation can be carried out by everyone, except for those women who suffer from severe forms of cardiovascular, respiratory failure, have a hernia, problems with coagulating blood system or general exhaustion of the body

Relative contraindications are conditions in which an operation is possible, but this involves some difficulties. It:

• Significantly expressed subcutaneous fatty tissue;

• untreated infectious diseases;

• Adhesive process;

• effusion or presence of fluid in the abdominal cavity more than 1 liter.

But modern gynecologists, having the technique of laparoscopic operations, after pre-examination with such diseases, prescribe a course of treatment, sanitize the foci of infection and perform surgical intervention. At the same time, all the pros and cons are weighed before performing a laparoscopic operation.

Preparing for an operation

From the responses of women who have undergone removal of the uterus by a laparoscopic method, it is known that the patients are unhappy only with the preparation: the operation lasts 40 minutes, and the training takes 2 weeks or more.

The woman should come to the operation after the tests have been submitted and the results obtained:

• blood tests (general, biochemical, blood type and Rh factor, hepatitis, syphilis and HIV, coagulability, glucose determination);

• analysis of urine - general and on the definition of sugar;

• Smears;

• electrocardiograms;

• Fluorography;

• Ultrasound;

• colposcopy;

• examination of specialists: a therapist, if necessary, a cardiologist, etc.

Before the operation for patients with uterine myoma, separate diagnostic scraping of the uterus and obtaining of histological results are required. This is necessary to address the issue of the scope of surgical intervention and the exclusion and prevention in the future development of cancer processes.

All the examinations are a necessary procedure and only after a full investigation the surgeon can perform the removal of the uterus by the laparoscopic method.

The day before the operation, it is not recommended to eat, it is necessary to shave off the pubic hair.

Before the operation, the woman fills the consent form for anesthesia and separately for the operation. If necessary, a pharmacological or psycho-preventive preparation for surgical intervention is performed.

Operation technique

Surgery to remove the uterus by laparoscopic method is performed with myomas up to 16 weeks gestation, which are complicated by bleeding, characterized by rapid growth or the risk of malignant degeneration. Although some experienced specialists completely remove the uterus, the size of which is about 20 weeks. But most often, given the age of a woman, the removal of uterine myoma by laparoscopic method is carried out with the leaving of a small part of the uterus for menstruation.

Use three or four punctures of the abdominal wall (one - near the navel, two others - on the sides) and inject trocar. This device is equipped with a camera for monitoring or a light installation with a supercharger of carbon dioxide or nitrous oxide and tools.

After examination, the uterine fibroids are removed by laparoscopic method. To do this, cut ligaments, ligate the vessels, cut the uterus from the walls of the vagina and remove it through the vagina through incisions in the vaults. This operation is called laparoscopically assisted vaginal myomectomy. Conduct suturing incisions in the vagina. In one operation, it is possible to delete several nodes without re-intervention.

At the end, blood or fluid accumulated during the operation is removed, and the organs and walls of the abdominal cavity are examined once more. Carefully check whether the vessels are well ligated and ligated, whether there is sweating of blood or lymphatic fluid. Eliminate gas and remove tools. Then, sutures are applied to the skin and subcutaneous tissue in places where trocars are introduced, and the skin is covered 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 with an operation such as removal of the uterus by a laparoscopic method: reviews

Which anesthesia is better? This question should be solved by the surgeon in conjunction with the anesthesiologist, taking into account the general condition of the patient, the indicators of laboratory studies, the estimated volume 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 the operation, such as removal of the uterus by a laparoscopic method.

The postoperative period with proper anesthesia leads to good results after the intervention: the pains do not disturb, there are only minor discomfort that occurs after 2 days. Sometimes there may be nausea, but this is stopped by Metoclopramide. 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, sour-milk products. The discharge is carried out on the second day after the intervention, and the sick leave is closed after 30 days. After this, a woman can safely go to work, but with the restriction of heavy physical labor for a month. Sutures are removed for 5 postoperative day.

After the operation, complications that are rare are possible: trauma of the internal organs by the trocar, bleeding from insufficiently ligated vessels, subcutaneous emphysema. All this can be prevented if one strictly observes the technique of the operation and carefully revises the abdominal cavity.

Effects

It should be noted that after such an operation as removal of the uterus by a laparoscopic method, the consequences are usually minimal. Recovery occurs after 2 weeks of rehabilitation. In 30 days after the operation a woman can deal with her usual affairs. Recommended physical exercise. But a month later, it is undesirable to load the abdominal muscles, lift weights, and be in the sun.

In the first days, minor pulling pains in the lower abdomen are possible. This is normal, and should go through 1-2 days. The formation of an adhesion process is possible, but according to statistics this occurs extremely rarely and only with a genetic predisposition of the organism or with pronounced endometriosis.

There may be minor discharge from the genital tract. This is normal if the ovaries are preserved. They continue to produce hormones, which cause this reaction.

Cases of inflammatory processes after laparoscopic operations 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 fertility of the patient is restored almost immediately, and in some cases, even an increase in libido occurs. A woman can live a sexual life 1 month after the operation. If the organ remains, you can become pregnant six months after the intervention.

Where can I perform the operation?

Many medical institutions can offer removal of the uterus by laparoscopic method. In Moscow, city hospitals, which are equipped with equipment and have specialists who own this technique, will offer you these services. The price of surgery is negotiated with the attending physician.

The examination can be conducted in the ward itself or in a hospital in the community. To conduct such operations, a quota may be issued. The cost of laparoscopic removal of the uterus is approximately 45 to 70 thousand.