Removal of the uterus laparoscopic technique, preparation for surgery and recovery
Removal of the uterus laparoscopically promotes minimizing damage of the skin and postoperative complications.
Despite the relevance of the methodology, the rationality of its application should be confirmed with medical evidence. Full comprehensive examination of the body will help to identify the need for laparoscopy.
Indications demonstrate how
Removal of the uterus laparoscopic method shown in the following cases:
- uterine fibroids;
- pathological change of the endometrium, combined with inflammatory processes in the cervix and cervical canal;
- hyperplastic process of the endometrium, not amenable to conservative therapy;
- the presence of various neoplasms in the uterus (multiple and atypical polyps) and fallopian tubes;
- emergency postpartum removal of adherent placenta;
- simultaneous removal of the uterus and ovaries in case of progression of the inflammatory process;
- recurrent bleeding of uncertain etiology.
Laparoscopic method involves the removal of organs in several ways:
- Amputation of the uterus. This involves the removal of the uterus without the cervix. Such an operation is shown, in particular, in case of confirmed diagnosis of fibroids, and also to prevent the development of pathological process in the neighboring organs of the urogenital area. Removing uterine fibroids laparoscopically is a widely used type of surgical treatment.
- Extirpation of the uterus. Removal of the uterus along with the cervix. Surgery is indicated when distributing the pathological process in all departments of the authority.
- Hysterosalpingogram. Includes not only removal of the uterus, but the fallopian tubes and ovaries. The removal of reproductive organs is indicated for extensive inflammation, peritonitis, rebirth into a malignant tumor, bilateral purulent inflammation of the ovaries. Radical surgery is carried out only in exceptional cases, when there is a direct threat to life.
- A radical hysterectomy. This procedure involves the removal of the uterus and other reproductive organs, adipose tissue, inguinal lymph nodes to prevent the spread of the cancer process. Cancer of the reproductive system is the major indication for such operation.
Types of surgery
Surgery determined by the physician based on the medical history data, overall health of the patient, and other factors. There are the following options:
- The laparoscopic method is recognized as the most gentle way to remove the uterus with special instruments through small puncture in the abdominal cavity. The operation is performed, after launching into the abdominal cavity gas. This allows you to push the organs of the peritoneum for more detailed diagnosis of the affected area.
- Laparoscopiceski method shown in the case of confirmation of malignancy or extensive inflammatory process with pus formation. Laparotomy rational for large-scale pathological process. Surgical manipulations are performed through an incision in the abdominal wall.
- The vaginal method of radical hysterectomy (amputation of uterus between body and cervix) is produced through an incision in the vaginal wall. This option is suitable in cases of prolapse of the uterus, as well as involvement of cervical inflammation and cervical canal. Due to lack of visual inspection, this method is combined with laparoscopy.
Preparing for surgery
The preparatory period before surgical intervention provides a security within 7 – 14 days and preparations for the operation. To key preparation activities include:
- the restriction of sexual activity (use of barrier methods of contraception);
- correction function of hematopoiesis (use of iron supplements to correct anemia, as well as agents that affect blood viscosity);
- the use of treatment of gonadotropin-releasing factor with the purpose of correction of ovarian and reproductive function;
- a colposcopy with histological examination of a tissue fragment;
- cytological smear from the vagina and cervical canal on the pathogenic flora, including sexually transmitted diseases;
- blood tests (including a test for coagulation, blood chemistry);
- a chest x-ray;
- electrocardiogram and subsequent consultation;
- ultrasound examination of small pelvis;
- correction of the diet — switching to easily digestible foods (cereals, vegetables, milk products);
- preparation of the intimate zone (shaving of hair);
- preparation of special slimming underwear, stocking, bandage.
After a preliminary examination of the reproductive system and analysis the General health condition the doctor prepares the patient for the procedure. Stress factor plays an important role. The loss of reproductive functions (especially at a young age) is always a heavy psychological trauma for any woman. Sometimes you need help of a psychologist.
Laparoscopic surgery is the most sparing method to remove the uterus. Determine the method of anesthesia, the doctor proceeds to surgical intervention. In the abdomen it makes several punctures with a diameter of 2 inches. In these openings are installed special devices: a laparoscope with an installed video camera and illuminating device, and a manipulator (tool for the manipulation).
Visual inspection inside the abdominal cavity using sterile carbon dioxide gas, allowing you to create additional space between the bodies. Identifying the affected area, the doctor proceeds to action, manipulating the tools. For the duration of the procedure is affected by the amount of work required and the experience of the specialist. Amputirovannyy the uterus (and other organs) are removed through an incision in the lower abdomen or the vaginal wall.
Conducting laparoscopic surgery requires precise, coordinated action of the specialist. Not every medical facility provides services of this kind. For advice better to turn to experienced doctors in specialized clinics.
Despite the advantages of modern techniques, there are contraindications. These include:
- the impossibility of complete removal of the amputated body through punctures in the abdominal cavity due to the large size;
- large volume surgery, where the use of endoscopic instruments is irrational;
- cases where the vaginal method is more acceptable (for example, when total or partial prolapse of the uterus outside of the vagina);
- diaphragmatic hernia;
- a large number of adhesions around the intestines;
- a high degree of obesity.
Any intervention in the peritoneal cavity does not exclude the likelihood of complications in the form of:
- injury to adjacent organs while removing the uterus;
- bleeding from damage to blood vessels;
- the formation of adhesions;
- urinary incontinence;
- infection of the abdominal cavity.
Compliance with the required prevention measures in the postoperative period will prevent the development of complications.
After surgery, the patient is under strict medical supervision for 4 to 7 days. With the development of complications duration of hospitalization may be increased.
Slight pain pulling character in the lower abdomen and spotting are common the first time after the surgery. For pain prescribed the usual painkillers (Paracetamol, Nurofen). However, in the case of prolonged painful condition, bleeding or abnormal discharge from the vagina, consultation of gynecologist is imperative.
The personal hygiene in treatment of the wound surface with antiseptic solutions will alert secondary infection pathogenic flora. Wounds can be treated with a solution of brilliant green, methylene blue, furatsilina, margantsevokislogo, chlorhexidine. After discharge a woman self-care for the operated area, changing the bandage regularly.
From water treatments bath should stop until complete healing of the wound surface. You only have to use a warm shower, after having protected the bandage the damaged area. Genitals in need of complete hygiene with use of antiseptic solutions in the postoperative period. For the prevention of dysbiosis vagina to make a choice in favor of products with extracts of plants or herbal decoctions. Natural antiseptic, anti-inflammatory characteristics are such plants as chamomile, calendula, St. John’s wort, oak bark or willow.
The observance of the special regime in the postoperative period will accelerate the healing process. In the complex of necessary measures includes:
- regular consultations at the gynecologist;
- limitation of physical activity and refraining from lifting heavy weights
- refusal of sexual intercourse within the first 4 to 6 weeks after surgery;
- recommended Hiking in the fresh air with the aim of preventing thrombosis, congestive inflammation in the lungs, adhesive processes;
- the use of the bandage, the special slimming underwear, stockings in the postoperative period;
- the preference for clothing made from natural materials to provide natural ventilation;
- a balanced diet (a predominance of vegetables, fruits, dairy products, vitamin complexes);
- elimination of stress factor (use of antidepressants, sedatives, synthetic and vegetable origin);
- correction of hormonal background at the manifestations of climacteric syndrome.
Timely diagnosis of reproductive disease, the competent approach with laparoscopic method of surgery will reduce the possibility of injuring organs and the development of complications.