Laparoscopy for hysterectomy: pros and cons
Removal, or hysterectomy is a serious surgical operation carried out in accordance with strict indications and contraindications. Such surgical intervention may be required for women who have serious diseases of the female genital organs such as malignant neoplasms. Endoscopic removal of the uterus – a modern variety of such surgical interventions that benefit from classic abdominal surgery multiple counts. Conducting laparoscopy requires the proper organization of the preparatory phase and post-operative rehabilitation. The observance of these stages allows to increase the effectiveness of surgery and reduce the risks of developing early and late complications.
Hysterectomy is a complex surgical procedure that requires careful patient preparation and professionalism of the operating team.
Laparoscopic removal of the uterus has certain advantages compared to these types of operations. I want to highlight the following:
- The low level of trauma to the tissues, which allows to accelerate the healing of postoperative wounds.
- Short term stay in the hospital prevents the development of nosocomial infections and other specific complications.
- Low risk of adhesions, hernias, and other negative effects.
- The decrease in time of disability of the woman.
- Rapid recovery of quality of life after surgery.
However, if the uterus is removed laparoscopically, it has certain disadvantages, foremost of which is the necessity of transition to classical laparotomy with the development of complications during the operation.
Indications and contraindications
Laparoscopic removal of the uterus can be used in the following cases:
- Rupture of the fallopian tubes with the development of heavy bleeding.
- The need for surgical female sterilization.
- Tumor in the uterus, including metastases to the body and cervix.
- Atypical hyperplasia of the endometrium due to the high risk of its transition to a malignant tumor.
- The development of complications in childbirth related hemorrhage of the uterus or inability to separate the placenta.
In these cases, the attending physician selects the operative treatment as the primary. However, it is important to comply with existing and contraindications restricting the use of laparoscopy in women:
- The large size of the uterus even against the use of special medication.
- Prolapse of the uterus and cervix. In this case, you can use vaginal access for the operation.
- Large cysts in the wall of the uterus (diameter >8 cm) due to the complexity of their extraction through small holes in the wall of the abdomen. At a puncture of cysts, there is a possibility of dissemination of tumor cells or other unwanted content.
- Multiple adhesions in the abdominal cavity with involvement of the bowel loops.
- Obesity 2 and 3 degrees.
- Hernias of the diaphragm in any location.
If a woman has these contraindications, it is necessary to choose other types of surgery, it is allowed to use in these situations.
Preparing women for the procedure
Preparation of the patient for surgery should begin 5-7 days before. The woman in the compulsory passes the clinical analysis of blood, analysis of blood for HIV, hepatitis b and the activity of the blood coagulation system. Women are shown an ECG. Such training helps to avoid tolerance to laparoscopy, patients with existing diseases of the internal organs of infectious and noninfectious origin.
Exception of infectious diseases and decompensation of somatic diseases is an important process in the preparation for surgery.
Every woman should undergo a colposcopy, which consists in visual inspection of the vaginal epithelium. If any erosion or other pathological processes, laparoscopy delayed until recovery.
2 days before surgery and she should stick to a certain diet that excludes eating foods that contribute to gas production (fruit and vegetables, confectionery, etc.). The day before surgery you must stop taking food, the maximum release of the gastrointestinal tract.
Before surgery the woman on foot wear special compression stockings to prevent the development of thrombosis in the postoperative period.
Removal of the uterus laparoscopically is only possible when using anesthesia. As a rule, can be used two kinds of anesthesia: General and spinal, in which a woman retains consciousness.
After carrying out the selected method of anesthesia the surgeon proceeds to the operation. First, using a special needle into the abdominal cavity is pumped carbon dioxide gas, allowing to expand it and to provide better access to the organs. With the help of puncture in the abdominal wall introduces a laparoscope, which is a flexible probe with a camera and a light source. This allows the surgeon to visually monitor the progress of the operation and to monitor possible complications. In addition to the abdominal cavity and introduces various manipulators to directly to carry out surgical procedures.
Individual choice of optimal method of anesthesia should be performed by a qualified physician-anaesthetist, together with the surgeon.
Uterus via laparoscopy can be dropped parts, especially if it has fibromatous nodes and other tumors. This allows you to not go to a broad access in the form of laparotomy, while maintaining the advantages of laparoscopic surgery.
After the operation is completed, the laparoscope and instruments are removed and incisions on the anterior abdominal wall is carefully sewn with a. The woman is taken to the house where she can establish a medical monitoring until termination of the anesthesia.
On average, 3-5 days after laparoscopic hysterectomy, the woman is discharged from hospital, even if she removed only the uterus and its appendages.
As with any surgical procedure, laparoscopic removal of the uterus may lead to the development of negative consequences associated with the operation:
- Acute bleeding from the place of the removed organ or of the punctures on the anterior abdominal wall.
- The development of the infectious process in violation of the rules of sterility.
- Puncture of the intestine with development of peritonitis.
- The formation of hernias at the puncture site of the abdominal wall in the future.
- The development of adhesions.
Prevention and rapid relief of these complications is an important goal of a surgeon.
Laparoscopy is the removal of the uterus – a good method of surgical treatment of diseases with a number of important advantages: low invasiveness, short duration of hospitalization and high level of safety for the patient. All this allows to use the operation in a large category of patients with high efficiency.