Removal of the uterus laparoscopic technique: indications, preparation
Laparoscopy today has gained great popularity not only in gynecology but also in other fields of medicine, minimally invasive and highly effective surgery with minimal complications in the postoperative period.
Earlier laparoscopic method was performed gynecological surgery small amounts, but today, many doctors often use this type of surgery, even for large scale operations.
Hysterectomy is a common operation in gynecology which is called a hysterectomy. In what cases is laparoscopic removal of a reproductive organ? What are the advantages and disadvantages of the method? How is the preparation for surgery to remove the uterus? Is it possible complications?
When shown the removal of the uterus?
Direct indications for hysterectomy are the following cases:
- The presence of malignant tumors of the body and/or cervix. In this case, the hysterectomy is the only effective method of treatment. If there are metastases in addition to surgery to remove the reproductive organ required irradiation and chemotherapy.
- The myomatosis. Myoma is a tumor in the uterus benign nature. The disease may be such symptoms: pain in the pelvis, heavy bleeding, anemia. In very advanced cases, removal of the uterus is the only possible method of treatment.
- The endometriosis. The inner membrane of the uterus, for whatever reason, begins to grow in the fallopian tubes, ovaries, other organs of the peritoneum. If a course of conservative treatment and even surgery did not give the expected results, assigns a hysterectomy.
- A rich, ongoing bleeding from the vagina. If a course of conservative treatment proved ineffective, hysterectomy may be the only way out.
When laparoscopy is contraindicated in hysterectomy?
Despite the enormous advantages of the laparoscopic method of surgical intervention, there are several contraindications for application, namely:
- Loss of reproductive organ (uterus went beyond the genital slit). The operation in this case is only possible via vaginal access.
- The presence of ovarian cysts of large size.
- Significant uterine size (more than 20 weeks of pregnancy). This contraindication can be called relative, because an experienced surgeon can take for a laparoscopy and then.
Kinds of hysterectomy
Based on the results of preliminary studies, the doctor makes the decision about how much will have surgery to remove the uterus and how it is best done. To date there are principal:
- Removal of reproductive organ above the vagina. During the surgical intervention removed the body of the uterus, while the cervix remains.
- Vaginal hysterectomy assisted by laparoscopy. In this case, via laparoscopic access intersect vessels and ligaments, which carry the power of the body, after which surgical intervention is continuing through the vagina.
- Hysterectomy laparoscopic. The surgery is performed via laparoscopic access. Through the vagina is cut off the body and is sutured to the vagina.
- Total hysterectomy by laparoscopic method. In this case, the operation is performed using laparoscopic access, including the amputation of the genitals and suturing of the vagina.
- Radical removal of the uterus. Genitals along with the cervix, lymph nodes and okolomatocnah fiber is removed via laparoscopic access. As a rule, such radical surgery is performed for cancer of the female genital organs (body and cervix, ovarian, endometrium).
The main advantages of laparoscopy
Removal of the uterus laparoscopic method is often used because of such advantages:
- A small trauma. The surgery is performed through small incisions in the abdomen. This means that the operation is better tolerated and do not have complications.
- A good cosmetic effect.
- Quick recovery period.
A good overview of the pelvic organs. The image in magnified form is displayed that allows the surgeon to see everything he does. This is very important if endometriosis, adhesions, cysts.
How is the operation to remove the uterus laparoscopically?
Laparoscopic removal of the uterus is performed without large incisions in the abdomen. Through small incisions in the abdominal cavity are introduced laparoscopic instruments and a video camera. The doctor performs manipulation, and the operation is displayed on the camera monitor screen. The doctor had a good opportunity to see what is happening, as well as access to the uterus, the abdomen in the beginning is filled with gas.
Laparoscopic method can be used in two variants, on which more details will stay on.
- Vaginal hysterectomy assisted by laparoscopy. In this case, the operation is performed in the combination of these two methods. First is laparoscopy, which is aimed at separation of adhesions, excision of endometriosis, removal of ovaries and tubes the uterus, the intersection of the top portion of the ligaments of the body. After these manipulations, the doctor continues the operation through the vagina. Thanks to this operation reduces injuries, more easy will be the rehabilitation period, and was also observed fewer complications. In addition, achieving a good cosmetic effect, because the stomach will only have a few small scars that will eventually become invisible.
- Total laparoscopic hysterectomy. The essence of the operation is that only the uterus is removed laparoscopically. In the beginning of the operation the doctor makes on the woman’s stomach incisions. Using the cannula, filling the abdominal cavity with gas. Through the incisions also introduced a trocar, and after them in the abdominal cavity is entered, the camera and special tools. During surgery, the surgeon crosses the uterus. If necessary, intersects the ovaries and fallopian tubes, and uterine artery bandaging. To retrieve deleted fragments from the vagina a small incision in the abdomen or an incision in the vagina. If there is cancer, removal of reproductive organ be made to nearby lymph nodes.
Usually, laparoscopic surgery characterized by a low rate of complications. In rare cases, there may be inadvertent injury to the internal genital organs, blood vessels, exposure to the gas which is introduced into the abdominal cavity, on the body, hematoma, infection.
How to prepare for surgery?
Before surgery you need to undergo a full examination. Only after receiving the results of the examination the doctor may decide on the volume of surgical intervention and method of holding
Appointed by such types of surveys:
- ultrasound examination (sonography of the pelvic organs);
- blood analysis (General, biochemical, coagulation, hepatitis, group and rhesus of blood, immune deficiency, syphilis, glucose);
- urinalysis (for sugar content);
- a swab from the vagina;
- photo x-rays;
In some cases, is also assigned examination by other doctors, particularly General practitioner, cardiologist. The day before the laparoscopy is not recommended to eat.
After surgery to remove the uterus laparoscopically consequences, in most cases will be minimal. A month after the operation, the woman will be able to return to normal rhythm of life.
The recovery period is not recommended for heavy exercise, especially abdominal muscles.
The first few days after a laparoscopy woman can feel a slight dragging pain in the abdomen. This is normal and should go away in a few days.
In rare cases, the formation of adhesions, as a rule, in severe form of endometriosis or by genetic predisposition.
Also there can be a slight vaginal discharge. If the ovaries were retained, they continue to produce hormones, so the phenomenon is considered normal.
It is rarely possible inflammatory processes in the genital organs. This happens if the woman does not comply with the recommendation of a physician, in particular, antibacterial treatment, a course which is the first 5 days after surgery.
To avoid unpleasant consequences, you need to follow doctor’s orders for adjustment of water and electrolyte balance of the blood.
A positive outcome of laparoscopic hysterectomy depends on the skill of the doctor. Only in this case the effects of surgery will be minimal, and the recovery period as easy as possible.
Women should not be afraid of hysterectomy and ignore doctor’s orders. This may be the only option not only to get rid of unpleasant symptoms and save a life. And the doctor will choose the most suitable method of operation, all factors considered individually in each case.