Laparoscopy ovarian cyst: features of the operation
When setting the woman’s diagnosis — ovarian cyst — important is diagnosis to determine the type, nature and structure of education. It will depend on the success of subsequent treatment with medicines or surgery. When choosing a method of treatment necessarily take into account such factors, women’s age, whether to retain reproductive function, is there a risk of the degeneration of education into a malignant tumor.
If the operation to remove the ovarian cyst, in the absence of contraindications can apply the method of laparoscopic surgery, due to the high efficiency and less trauma compared with the abdominal procedure.
What is an ovarian cyst?
Cysts are benign neoplasm in the ovary cavity with the liquid. They can be single or multiple (polycystic ovarian syndrome (PCOS)) in size are large and small.
The factors causing the formation of cysts — inflammation of the female genital organs of a chronic nature and hormonal imbalance.
The cysts are:
- Functional (luteal or follicular). This species may occur due to hormonal disruptions in the body. They resolved on their own.
- Cystic (serous, mucinous, dermoid) removed by a surgeon.
- Endometrioid cyst removed the surgeon.
- Barbarella is nazyaetsya cyst of the epididymis.
Advantages of laparoscopy can be considered:
- reduced the degree of injury during surgery;
- more rapid rehabilitation;
- the period of stay of the patient in hospital after surgery much less.
Features laparoscopy ovarian cyst
There are 2 ways of doing a laparoscopy, if you want to remove the cyst. Option 1 is the removal of the cyst. This type of surgery is called a resection of the ovary, cystectomy, husking cysts. When method 2 is removed together with the ovary (adnexectomy, oophorectomy).
Completely the ovary can only be removed during the menopause or at risk of tumor growth. If not, then the surgeon leaves the maximum possible area of tissue of the ovary, which has no losses. If the cyst appeared long ago and completely replaced ovarian tissue, after valesiana remains only a tiny piece of cloth. The task of the surgeon to try to save even the smallest piece of ovarian tissue.
During the operation to stop the bleeding from the ovary, some surgeons have used aggressive techniques. Bleeding face the fact that the ovary after surgery will recover much longer and may not recover. The surgeon should try to remove the ovarian cyst so that capsule was opened and its content is not caught in the abdominal cavity. This will help to avoid serious complications.
When performing laparoscopy endometriotic cysts it is very important to remove as much lesions, otherwise the operation will be ineffective. In practice, the laparoscopic method of removal of ovarian cysts is often combined with other types of surgery, such as checking the fallopian tubes for patency, and division of adhesions, removal of fibroids.
Indications for an exploratory lap
Laparoscopic surgery of ovaries are shown:
- if an ovarian cyst has ruptured;
- if the cyst is big;
- if twisting of the uterus;
- to determine the type of cysts;
- at the risk of the transition of endometriotic cysts cancer;
- if the tendency to growth of the cyst.
When laparoscopy is contraindicated?
The main contraindications to laparoscopy ovary can be considered:
- a coma, clinical death;
- failures of brain blood circulation;
- hemorrhagic shock;
- myocardial infarction;
- the presence of cancer;
- of blood clotting;
- pathology of the heart in an acute form.
Preparing for surgery
Despite the fact that laparoscopy ovarian features easy implementation, as with any surgery requires careful preparation.
Before its implementation need to be tested:
- General analysis of blood and urine (valid 10 days);
- blood clotting;
- biochemical blood analysis (total protein, urea, glucose);
- a blood group;
- tests for hepatitis, syphilis, HIV (the test results are valid for 3 months);
- the smear of vaginal flora.
- Ultrasound of the pelvic organs;
- photo x-rays or chest x-ray;
- CT or MRI (if indicated).
The woman should sign the document to indicate the consent for surgery.
Preparation for surgery should begin with an enema. One the procedure is performed the evening before surgery, the second morning. You can eat not later than 18.00, and drink — not later than 22 hours. It is necessary to shave the hair in the bikini area. Before entering the operating antivarikoznye need to wear stockings, wear them also need another 1-2 weeks after surgery. This measure will reduce the risk of microthrombi in the veins of the lower extremities.
What is the procedure?
Laparoscopy of ovarian cyst is performed under General anesthesia. Sometimes surgery for PCOS and a single cyst is performed under local anesthesia. It is divided into 2 phases: research (size, condition, cyst, single or multiple) and emptying of endometriotic cysts, and excision of the affected tissue.
First, put an intravenous catheter through which the necessary medications will be ingested. After the anaesthesia takes effect, the patient was installed urinary catheter, if necessary.
In the next stage of the laparoscopic method of doing the operation, the peritoneum is filled with gas so the surgeon can see the organs. The peritoneum is a few punctures, they introduce the instruments and the laparoscope displays the image on the screen. The doctor conducting the operation, controlling the image of organs on screen. Cyst or multiple education in PCOS is removed laparoscopically with the tools of the surgeon, the healthy ovarian tissue interference. In the next stage, the gas is released from the abdominal cavity by a special device, and at places overlaps the suture and sterile dressing. In some cases, can be installed a drainage pipe which is removed a day after the laparoscopic method of surgery to remove ovarian cysts.
The duration of laparoscopy in PCOS and single education depends on the individual characteristics of the woman and severity of the disease. So, in the case of multiple entities the operation will be longer than when a single cyst. The average duration of surgery by laparoscopy-a — 15 minutes-1 hour. The duration of the operation also determines the qualification of the surgeon.
The laparoscopic method of removal endometriodnoy ovarian cysts
On the surface of ovary or inside it can be formed endometrioma cyst. It is completely limited by walls with different thickness, and inside — dense content. If during menstruation the walls of the cyst are damaged, the fluid can get into the abdominal cavity. Therein lies the danger.
In most cases, the woman is not even aware of her appearance, in that time, as endometrioma cyst threatens reproductive disorders and infertility. The disease is treated surgically, because of the ineffectiveness of other treatment methods, as well as to minimize the risk of malignancies.
Laparoscopic method of treatment of pathology is the most common. As a rule, endometrioma ovarian cyst is bilateral and is characterized by rapid increase in size. When you remove endometriodnoy cysts laparoscopically in the early stage of the disease surgical intervention is safer and the rehabilitation period will be easier. The likelihood of complications and significant changes in the female body — are much lower.
Paraovarian cyst: removal of the laparoscopic method
This type of cyst is a tumor formed from the appendage of the ovary. The disease can be asymptomatic and with pronounced symptoms. Paraovarian cyst will never resolve on their own or with the help of «folk methods», and that is its danger. In this case, only the surgically removed.
Often paraovarian removal of the cyst is performed laparoscopically. After operation by this method, the woman feels normal, the reproductive system is gradually returning to normal. In most cases, recurrence of the disease there.
The doctor taking the decision on carrying out of a laparoscopy paraovarian ovarian cysts, taking into account the following factors: the presence of discomfort, the size of the cyst and the dynamics of its increase. If the sizes are large and the pelvic organs have other pathology, complications can arise after surgery.
Dermoid cyst of the remove by a laparoscopy
Benign neoplasm that appears on the body of the ovary is called a dermoid cyst. Education represents a dense capsule consisting of different tissues in a fluid, the consistency similar to jelly. In the composition of dermoid cysts can be fat, bone, nerve tissue, skin tissue, hair and teeth. While her small size, she can not to talk about himself. It is found primarily only after reaching a certain size, when it begins to adversely affect the adjacent organs, resulting in a woman will feel discomfort.
This species is characterized by constant growth, so removing it surgically, you need to conduct as early as possible. Laparoscopy with ovarian dermoid cyst – very easy and effective method of removal. After the surgery was performed, minimizing risk of recurrences.
Polycystic ovary syndrome (PCOS) treatment
If conservative methods in PCOS ovulation induction does not yield results, is assigned laparotomies the cauterization of the ovaries. However, there are also negative aspects: because of the high risk of adhesions more than 40% of operated women can’t get pregnant, although ovulation is restored. More effective method of conducting endoscopic surgery on the ovaries, causing the number of adhesions is much less, and the method itself is smaller injuries.
PCOS is a chronic disease, so conservative treatment methods will give only a temporary effect and the temporary improvement is a relapse. A woman with PCOS must be seen by an endocrinologist that will help to prevent the development of metabolic disorders, which after a while can go for cosmetic and reproductive changes.
The recovery period after laparoscopy
After laparoscopy, the woman may feel discomfort, expressed in unfounded fear, anxiety, sudden mood swings.
If necessary, the doctor may prescribe painkillers and antibiotics to avoid inflammation (at the beginning of the inflammatory process, the body temperature rises). If the temperature is not falling, it is necessary to conduct further examination to find the cause of its increase. If you have stitches, then take them off on day 7 after surgery.
The norm is, if my period will come in accordance with the schedule. If the patient will follow the doctor’s recommendations, recovery after laparoscopy ovarian cyst will go fast. 2-3 weeks after laparoscopic surgery the ability to work fully restored. There may be abnormalities of the menstrual cycle, which is not some kind of pathology. After some time the cycle will be leveled, and the amount of discharge stabiliziruemost. Due to the fact that laparoscopy ovarian cyst is an operation whose purpose — to save the body, it has no effect on pregnancy and childbirth in the future, as well as on the development of a fetus. Women of childbearing age after the laparoscopy ovarian cyst are prescribed hormonal therapy with the course of 3-6 months, which will allow you to maintain the hormonal balance and normalize the ovarian.
The most serious complications of laparoscopic method, which made removal of ovarian cyst or multiple entities with PCOS are considered to be injuries of abdominal cavity organs, in particular blood vessels and intestines. This happens due to the fact that the internal organs of the peritoneum have changed their location due to various pathologies (tumor, adhesions, abnormal anatomical structures).
In second place are the complications associated with infections. It should be noted foci of chronic infection, as well as a temporary decrease in immunity as a consequence of surgical intervention. Temperature after surgery can be a signal of anxiety. But if you have a fever and lasts only one day, nothing terrible in this. Cough, caused by the presence of the tube in the throat, which is served anesthetic, often causes pain in the area of punctures. To treat a cough is not necessary — it resolves on its own. If the cough is annoying, you can ask the doctor to prescribe the pills, its soothing.
There are also cases when carbon dioxide ends up in the abdominal cavity, and retroperitoneal space. The reason for this, too, is – incorrect insertion of the needle the Veress. As a result, there are unpleasant sensations in the postoperative period. To prevent serious complications, the surgeon must prevent, recognize and try to quickly eliminate.
What should be the diet after laparoscopy ovarian cysts?
Nutrition after surgery to remove ovarian cysts, should be as light as possible. It is important that the diet is necessarily present fiber in the composition. It is the fiber beneficial effect on the intestine and on the level of glucose in the blood.
It is recommended to follow the work of the intestine — its hard to recover, often there is a diarrhea or nausea. In the first month after surgery is not recommended to eat fatty, trudnosmyvaemye food not to irritate digestive tract and cause diarrhea.
You need to eat small portions up to 6 times a day — if you overload the stomach, then nausea and heaviness. The diet should be the foods that contain cereals, juices, accelerates the healing process. Alcohol should not be consumed within one month.