Laparoscopic removal of the uterus - what are the advantages?
Laparoscopic surgery has been around for over 20 years. And during this time she has established herself as a minimally invasive and effective method with minimal postoperative complications.
Laparoscopic methods in gynecology have gained great popularity. Previously, this method was carried out gynecological operations of small volumes. But lately it has become commonplace in most clinics and hospitals. One of these operations is the removal of uterine fibroids laparoscopic method. Patient reviews indicate that there is a rapid restoration of efficiency, the risk of complications and adhesions is small, and slight damage to the skin does not spoil the appearance of a woman.
For the operation requires qualified and experienced professionals. The intervention in this case is justified by minimal complications. In some cases, a combination of laparoscopic and conventional surgery is simply necessary to save the patient's life. This specialist will select the correct 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 laparoscopy.
The main advantages of the method:
• low degree of trauma,
• rapid restoration of the functions of all organs,
• reduction of postoperative pain,
• short hospitalization,
• stay in a day hospital,
• reduction of terms of disability,
• minimum of postoperative hernia,
• minimum time for rehabilitation,
Types of operations
By the nature and location of the access (cut), the uterus can be removed by one of three methods.
- Laparoscopic surgery to remove the uterus. This is the most benign method. It is carried out from several small cuts where special tools are entered. Pre-abdominal cavity is filled with sterile gas, which allows you to move the internal organs from each other. The survey is carried out using a video camera, which is also inserted into the abdominal cavity.
- Laparotomic type of operation performed through one large incision in the abdomen. This access is resorted to with proven cancer, and also if an extensive purulent fusion of tissues with peritoneal lesions has occurred (this is called peritonitis). If the operation began as a laparoscopy, then when the above changes are detected, physicians should proceed to laparotomy.
- Extirpation can be made from the vaginal access when the incision is made in the vagina (usually the uterus is removed from it). Most often it has to be supplemented with laparoscopic intervention, since the review from this access is small.
Benefits of the laparoscopic technique
Laparoscopic removal of the uterus is the optimal and least traumatic method with a short rehabilitation period. Laparoscopy has a low risk of adhesions, as well as reduces the operating and drug load on the heart and other organs. With such a minimally invasive intervention, the period of hospitalization and disability is shorter than when using other surgical approaches.
Laparoscopic hysterectomy may be used for:
- combination of cervical diseases (scars, hypertrophy, ectropion, precancerous changes) with multiple fibroids,
- recurrent or atypical endometrial hyperplasia in women over 40,
- cancer of the uterus, multiple or atypical polyps,
- emergency surgery is carried out after delivery, when there is no exfoliation of the adherent placenta or myometrium cannot be reduced.
Removal of the uterus and ovaries using laparoscopy is used for progressive ovarian tumors, a combination of sclerocystosis or ovarian apoplexy with a uterus tumor, purulent inflammation of the ovary, when uterine tissues and neighboring organs are involved in purulent melting.
Laparoscopic surgery is performed through small (usually 0.5-1.5 cm) holes.
In women older than 50 years, hysterosalpingo-ovariectomy is performed with heavy uterine bleeding, the growth of tumors of one of the reproductive organs. Hysterectomy and removal of one or two appendages to patients of the older age group who are at risk of developing a malignant tumor are performed.
Under the "removal of the uterus" understand the different volume of the operation, which depends on the disease:
- Supravaginal amputation. This is the name of the removal of the body of the uterus, when its neck and appendages remain in place. It is carried out in case of large volumes of myomas, adenomyosis, postoperative complications and the atypical form of endometrial hyperplasia, abundant uterine bleeding and pelvic pain when the cause of these phenomena has not been clarified.
- Total hysterectomy. In this case, both the body and the cervix are removed, but the tubes and ovaries remain in place. Such an intervention is performed for endometrial cancer.
- Radical hysterectomy. So called removal of the uterus and appendages. The method is applicable only if a cancer tumor is detected that spreads to one of the appendages. If the cancer spreads from the body to the cervix, the initiated laparoscopic intervention expands to a laparotomic one. Not only the uterus, its neck, tubes, and ovaries are removed, but also the inguinal and pelvic lymph nodes, often the upper sections of the vagina.
The older the woman, the more doctors tend to perform a more radical operation. Gynecologists in the United States even perform the removal of the uterus along with the cervix in women over 40 years old who have no reproductive system diseases. So, they say, the risk of developing high-grade ovarian cancer is reduced by more than 3.5 times. This is especially important for those who are hereditarily predisposed to the development of oncology, including breast cancer.
The laparoscopic method is not used in such cases:
- The uterus has a size of more than 16 weeks, even after treatment with drugs - gonadotropic releasing hormone agonists.
- Prolapse of the uterus. In this case, the optimal access is vaginal.
- Ovarian cystoma, that is, cysts, whose dimensions are more than 8 cm in diameter. Such formations filled with fluid cannot be removed through a small laparoscopic incision without making punctures. And it is impossible to pierce this formation: it may contain cancer cells, and because of the puncture, they can get into the peritoneum and internal organs, and grow into them.
- The presence of fluid in the abdomen in a volume of more than 1 l (in this case, need laparotomic surgery).
- Many abdominal adhesions that surround the intestines.
- Impaired blood flow in the brain stem (vertebro-basilar insufficiency).
- Diaphragmatic hernia.
At the preparation stage, anemia is being treated, which is possible due to heavy menstruation. To do this, proceed from the situation: or prescribe iron supplements, or, in the case of low hemoglobin, are hospitalized and blood transfusions are performed.
If a woman preparing for laparoscopic removal of the uterus, has a large size body to be removed, she needs to undergo a 3-6 month course of treatment with drugs from the group of analogues of gonadotropin-releasing factor.
The patient undergo colposcopy. In case of detection of erosion or other pathologies, appropriate therapy is carried out, and only after a month they plan surgery.
1-2 weeks before the surgery, the woman should be tested:
- smears from the cervical canal by the PCR method: for the presence of cancer cells and for the determination of chlamydia, toxoplasma, herpes viruses, ureaplasma,
- general clinical analyzes of urine and blood,
- blood clotting test
- blood glucose and its other biochemical parameters,
- blood type and rhesus
- tests for hepatitis, syphilis, HIV.
During the entire cycle in which the uterus is planned to be removed, it is not necessary to exclude sexual contacts, but they need to be protected only by barrier methods, without using hormonal means.
The operation is performed in the hospital, therefore, for the immediate preoperative preparation, it will be necessary to carry out hospitalization at least one day before it. This should be the period from the end of menstruation to ovulation.
The day before the operation, the woman will need to switch to light, easily digestible food (cereals, soups, mashed potatoes, dairy products). On the evening before, they cleanse the intestines with an enema to pure water, and also remove hair from the lower abdomen and pubis. Enema is repeated in the morning.
On the night before the operation and in the morning, an injection is made, which reduces the level of anxiety and fear of the upcoming manipulation. Since the operation is performed under general anesthesia, you need to stop eating at 18:00 pm, stop drinking 6-8 hours before the appointed time.
At the appointed time, a woman should wear compression stockings or stockings on her legs. She is escorted to the operating room, placed on the table, and then one catheter is placed into a vein and another into the bladder. Special medications are injected into the venous catheter, the patient falls asleep and feels nothing.
Postoperative period and rehabilitation
After removal of the uterus with the laparoscopic method, the rehabilitation period, although shorter than after the operation from laparotomy, lasts more than one month.
It will be possible to get out of bed only on the second day, having previously put on compression stockings on legs and a bandage on the stomach. Prior to this, a ship is used for physiological shipments.
Bandage and stockings will have to be worn every time you need to get up for 2 weeks. And getting up and walking is necessary as much as possible - for the prevention of adhesions and congestive pneumonia. In order to prevent the latter, it is also recommended to inflate balloons and blow through a narrow tube into the water.
For the first 3-5 days, the nurses will perform anesthetic injections and treat the wounds with antiseptics. After discharge, the doctor will write what can be used for anesthesia and smearing the seams at home.
Upon arrival home immediately take a shower or bath can not. It is necessary to wash in part so that the water does not fall on the seams. Shower can only be taken after 2 weeks, when the stitches are removed.
Important and diet after surgery. It is necessary to exclude all fatty and spicy dishes, sweets, coffee, chocolate, white bread. There will have 5-7 times a day, little by little, only cereals, vegetarian and milk soups, soups on the second and third broths, dairy products. The main thing - to prevent constipation.
Lifting more than 5 kg, "swinging the press" after removal of the uterus is prohibited. Gymnastics can only be done so that the doctor will allow. He should name the time when it is possible to resume sex life.
In the postoperative period, hormonal drugs prescribed by a gynecologist are required.
In addition to medicinal and physiotherapeutic treatment, the recovery course must necessarily include psychotherapeutic and psychological support.
Consequences and complications
After such a complex intervention as hysterectomy, the usual consequences are the cessation of menstruation and the impossibility of becoming pregnant.
If, apart from the uterus, the ovaries were also removed, during the first 20 days after the operation, the symptoms of menopause are observed: sweating, hot flashes, tearfulness, insomnia. If you do not take hormones that will imitate the work of your own ovaries, after a time there will be problems with the cardiovascular system, cystitis, vaginal dryness and itching often begin to disturb. Any injury to the limbs can lead to their fracture (due to osteoporosis), periodontal disease develops, and after a time, the thyroid gland is also impaired, which further aggravates the quality of life.
After removal of the uterus with a laparoscopic method, various complications can be observed: bleeding, suppuration, formation of adhesions, constipation, urinary incontinence, severe pelvic pain, blood infection (sepsis).
What is laparoscopy?
Laparoscopic hysterectomy - this is how in the medical community is called the removal of the uterus through laparoscopy. Laparoscopic uterine amputation is considered the best solution if the need arose for such an operative intervention. This technique has many advantages, among which the most important are:
Minimal trauma. Minor pain, the almost complete absence of adhesions. The absence of coarse scars and scars on the surface of the abdomen. In some cases, the removal of the uterus by laparoscopy allows you to save other reproductive organs - for example, the cervix. And it always has a positive effect on women's health. One of the undoubted advantages of laparoscopy is a short recovery period. As a rule, provided there are no complications, the rehabilitation process takes no more than 2 weeks - within a few hours after the uterus is removed, the woman is allowed to get out of bed and walk, and after 3-4 days she can be discharged from the hospital. About 2 weeks after the operation, the woman can return to an active, fulfilling life. This is very important for working women. The level of postoperative complications is minimal. During surgery, the surgeon carefully monitors each movement, so damage to other internal organs, blood vessels, as well as internal bleeding: both during and after the operation is extremely rare. After 4-6 weeks after the operation was performed to remove the uterus, a woman can return to sex. After laparoscopy, visible scars and scars do not remain on the surface of the abdomen.
Indications for laparoscopy
This method of uterus amputation is used in the following cases:
It is the laparoscopic removal of the reproductive organ that is recommended in case of cancer of the reproductive organs. Malignant neoplasms of the ovaries, cervix are considered the main indication for the removal of the reproductive organ - this allows you to stop the disease and prevent the spread of cancer cells to other internal organs. Rapidly progressive uterine fibroids, which manifests itself in many small nodes, or in several large neoplasms. Severe uterine bleeding, the nature of which is not revealed.
A serious indication for laparoscopy is pathological prolapse and prolapse of the uterus.
How is laparoscopic removal of the uterus?
Removal of the uterus by laparoscopy begins with the preparation of a woman for surgery. To do this, 7-10 days before surgery, you should refuse to take any medications. Ladies who smoke, it is recommended to give up the bad habit for a week before amputation. In addition, it should be remembered that for every woman of the fair sex, the removal of the most important reproductive organ is a serious psychological trauma. Therefore, in many cases, before a laparoscopic removal of the uterus, counseling by a psychologist will not be redundant.
Laparoscopy is considered one of the modern minimally invasive methods of surgical intervention. The operation is performed with general anesthesia. The surgeon makes several small cuts on the abdominal wall of the patient - about 3-4, no larger than 2 cm. Next, a special video camera, an illuminating device and all necessary surgical instruments are inserted directly through these incisions. In order for the doctor to obtain the necessary space for all surgical procedures, a certain dose of carbon dioxide is injected into the abdominal cavity. It slightly “lifts” the abdominal walls, providing maximum visualization and opening up the necessary view to the surgeon.
After the introduction of laparoscopic instruments, the doctor crosses the uterus, ligates the uterine arteries, and, if necessary, removes the cervix, ovaries and fallopian tubes. In order to remove amputated reproductive organs from the abdominal cavity, a small incision is made in the vagina or lower abdomen, through which the excised organs are removed. If there are several organs or the uterus is large, it is dissected into several parts, which are removed after the incision.
Surgery to remove the uterus - possible complications
The occurrence of complications after laparoscopic removal of the uterus is extremely rare - about 1 in 1 woman out of 100 undergoing this surgery. Among the possible complications are:
Несмотря на то, что во время операции хирург видит всю картину через специальный монитор и контролирует каждое движение хирургическими инструментами, в редких случаях не исключается случайное травмирование других внутренних органов. Повреждение кровеносных сосудов во время прокола брюшной полости или непосредственной ампутации репродуктивных органов. Certain damage to the female body can cause carbon dioxide, which is introduced into the abdominal cavity for better visualization. The appearance of adhesions in the pelvic area. In extremely rare cases, not exceeding 1% of all operations, the patient develops infectious complications.
Indications for removal
In which cases the uterus is removed:
The main reasons for the removal of the uterus are cancers of the ovaries, uterus, or cervix. Often, the uterus is removed in the diagnosis of fibrosis or fibroids (benign tumor) of the uterus, less often with endometriosis. In rare cases, the uterus is removed after delivery: with heavy uterine bleeding caused by trauma or postpartum infection.
Negative moments of laparoscopy
All these positive aspects in the process of operative intervention and recovery of a woman cover all the disadvantages that are characteristic of any laparoscopic intervention:
• equipment and training of qualified specialists requires significant material costs,
• the surgeon must be proficient in laparoscopic and conventional surgery,
• complications consist in dysfunction of organs associated with the injection of gas into the abdominal cavity, but with the correction and proper prevention of these complications, it can be avoided,
• the possibility of mechanical damage to various organs, tissues and structures is not excluded.
Removal of the uterus laparoscopic method. Kinds
When choosing a method of surgical 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, there are several types of surgery on the reproductive organ.
In practice, use:
- Total hysterectomy, when both the body and the cervix, the subtotal, is removed - the body of the uterus is removed. If, together with the uterus, the tubes are amputated — a histertubectomy, and if there are tubes and barrels, then such an operation is called a histerotubovarectomy. Radical operations, such as panhysterectomy - removal of all internal genital organs along with lymph nodes, omentum, nearby tissues and part of the vagina, are used in oncological processes.
- With small knot sizes and to preserve the fertility function, a woman-preserving surgery is performed. One of these is the removal of subserous uterine fibroids by laparoscopic method. With a minor lesion of the uterus, enucleation of the nodes is performed, i.e., exfoliating fibrous tissue with subsequent organ preservation. After such operations, a woman may become pregnant after some time and give birth.
The operation to remove the uterus with the laparoscopic method is performed for myomas with sizes up to 16 weeks of gestation, which are complicated by bleeding and are characterized by a rapid growth or risk of malignant transformation. Although some experienced professionals completely remove the uterus, the size of which is about 20 weeks. But more often, given the age of the woman, the uterus fibroids are removed by laparoscopic method, leaving a small part of the uterus for menstruation.
Three or four punctures of the abdominal wall are used (one is near the navel, the other two are on the sides) and trocars are inserted. This device is equipped with a camera for control or light installation with a supercharger of carbon dioxide or nitrous oxide and tools.
After inspection, the uterus myomas are removed by the laparoscopic method. To do this, the ligaments are excised, the vessels are ligated, the uterus is cut off from the walls of the vagina and removed through the vagina by means of incisions in the arches. This operation is called laparoscopically assisted vaginal myomectomy. The incisions are made in the vagina. In one operation, it is possible to remove several nodes without re-intervention.
In the end, blood or fluid accumulated during the operation is donated, the organs and walls of the abdominal cavity are once again examined. Carefully check whether the vessels are well ligated and ligated, if there is no blood flow or lymphatic fluid. Eliminate gas and remove instruments. Then sutures are applied to the skin and subcutaneous tissue at the sites of trocar insertion, the skin is sutured with cosmetic stitches.
The duration of the operation can be from 15 minutes to 1.5 hours, depending on the amount of surgery performed.
Anesthesia during surgery such as removal of the uterus with a laparoscopic method: reviews
Which anesthesia is better? This question should be solved by the surgeon together with the anesthesiologist, taking into account the general condition of the patient, the indicators of laboratory tests, the expected 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 will be awakened 15-20 minutes after such an operation as the removal of the uterus with the laparoscopic method.
The postoperative period with proper anesthesia leads to good results after the intervention: the pain does not bother, there is only a slight discomfort, which passes after 2 days. Nausea can sometimes be, but this is stopped by Metoclopramide. The first day you can drink only water. By evening, you can already rise and rise. On the second day, you can eat food that does not irritate the intestines: cereal, broth, fermented milk products. The extract is carried out on the second day after the intervention, and the sick-list is closed after 30 days. After that, a woman can safely go to work, but with the restriction of heavy physical labor for a month. The stitches are removed on the 5th postoperative day.
After the operation, complications that are rarely possible are: injury to the internal organs by the trocar, bleeding from insufficiently ligated vessels, subcutaneous emphysema. All this can be prevented if the technique of the operation is strictly observed and the abdominal cavity is carefully inspected.
Where can I perform the operation?
Many hospitals may offer uterus removal using the laparoscopic method. In Moscow, city hospitals that are equipped with equipment and have specialists who own this technique will offer you these services. The price of the operation is negotiated with the attending physician.
The examination can be carried out in the department itself or previously in the hospital at the place of residence. For such operations it is possible to issue quotas. The cost of laparoscopic removal of the uterus is approximately 45 to 70 thousand.
What is the uterus, and what function does it perform
The uterus is a reproductive organ in the female body that is responsible for the continuation of the species. In its structure, the body resembles a small bag, which is covered with elastic muscles. As a rule, the main function of the uterus is carrying a fetus from conception to birth. Just like other organs, the pear-shaped hollow body is fed by blood vessels. Despite the general opinion, the body is not responsible for the production of hormones, such as the ovaries, the thyroid gland and the pituitary gland, but is important for those who want to make a healthy baby.
Note. The uterus is a capricious organ that can easily dislodge if the body is subjected to excessive loads. It is for this reason that a woman is not recommended to lift weights more than 2 kg in one hand. And also distinguish and pathologies (defects) of this organ, for example, omission, prolapse or doubling.
Why can amputate the uterus
It should be noted that the operation to remove the uterus is appointed only by the surgeon and strictly after a full examination.
The main reasons for the removal:
- Benign / malignant fibroids. In this case, the body can only be amputated for medical reasons. The number of fibroids on the muscle tissue, and their size, and diameter are also taken into account. Also, a woman with fibroids should be tested for histology. There are cases when fibroids are benign, that they can be removed without damaging the genital organ. It helps women up to 50 years to bear children, without harm to their health. By the way, in women after 50 years of uterine fibroids can lead to cancer.
- Oncology of the female genital organs. If the metastasis has spread to the ovaries, the cervix, then amputation is often prescribed.
- Omission or prolapse of the hollow body. There are 4 degrees of pathology. If a woman is diagnosed with a 3rd or 4th degree prolapse, then the uterus can be removed.
- Organ rupture during labor or pregnancy.
- Excessive bleeding, especially in the postpartum period.
Laparoscopy of the uterus: what is it
Removal of the uterus with a laparoscopic method allows you to avoid the formation of large scars on a woman’s abdomen. This is one of the most effective procedures, which reduces the risks of both bleeding during amputation and the occurrence of complications in the postoperative period.
In medicine, laparoscopy is not only the removal of organs with minimal risks, but also a universal method of diagnosis. For the procedure used manipulators, or tools that allow you to assess the state of the internal organs through the smallest cut. If during the diagnosis requires surgery, the surgeon makes several punctures through the abdominal cavity.
The main feature of the procedure is the use of special tools. They are equipped with microscopic cameras and illumination, which allows the specialist to carry out the most complex operations without having to open the abdominal cavity. Removal of the uterus with a laparoscopic method does not injure muscle tissue, which prevents the formation of hernias, adhesions and tears. In this case, the procedure is not performed without anesthesia, because a woman can feel how her stomach is inflated and cuts are made, even if they are minimal.
How is the removal of the uterus with laparoscopy
Removal of the uterus laparoscopic method takes place in several stages.
- Preparing the patient for amputation. As a rule, within a few days a woman is prescribed a special diet and solution for a complete bowel cleansing. On the day of surgery, the patient is given an enema twice a day, and an ultrasound scan is performed and the readiness for surgery is confirmed.
- Anesthesia and the beginning of the operation. Amputation is carried out either under local anesthesia or under general. After the woman's body is ready for the procedure, the surgeon carefully makes several incisions, where cameras, lights, and instruments for amputation are inserted. Immediately after anesthesia, a gas is introduced into the abdominal cavity, which expands the walls of the abdomen. This allows for a preliminary diagnosis of the pelvic organs and start the operation.
- Uterus removal. The surgeon and his assistants monitor the progress of the operation through the monitor, which displays images from one of the cameras inserted into the abdominal cavity.
- Cleaning the abdominal cavity. After amputation, it is necessary to check whether all vessels are clamped and there is no bleeding. During the completion, blood residues are removed, all instruments are removed from the cavity. It should be noted that all the seams after removal of the uterus cosmetic, neat.
The cost of laparoscopy
Now the removal of the uterus with the laparoscopic method is one of the most popular surgical procedures. All because of the minimal risks, barely noticeable stitches and careful removal without damage to the adjacent tissues of the abdominal cavity. Let's look at the cost of laparoscopic surgery to remove the uterus, both in Russia and in other CIS countries and Europe.
- Russia. The average cost of the procedure with all associated tests ranges from 90,000 to 120,000 rubles. It is also necessary to take into account the reputation of clinics. For example, if there is only one clinic in the region where high-quality laparoscopy of the uterus is performed, the cost can vary from 90,000 to 150,000 rubles. In addition, for non-resident provision of a bed during the rehabilitation period may amount to an additional 30,000-60,000 rubles.
- Germany. On average, the total price tag can reach 8 000-10 000 euros. The price includes travel, accommodation, and a full examination by the best specialists, as well as rehabilitation and observation in the postoperative period. For residents of the CIS countries, the amount can reach 800,000 rubles.
- Israel. Despite the fact that Israel has one of the most competent and qualified specialists in the world, the cost of the procedure can reach only 400,000 rubles.
Why such a cost? Because the laparoscopic method is almost a bloodless operation that requires the use of the best skills and specialized tools. At the same time, the procedure does not affect the cost. Laparoscopy of the uterus can take place both within 15 minutes and for several hours.
If there are no contraindications, then this operation is done with general anesthesia. In modern German clinics, the operation lasts about 30 minutes. In place of the incision remains a seam approximately 20 cm in length, it can be horizontal or vertical. It is necessary to wear a postoperative bandage after removal of the uterus for better healing of tissues.
Why pain occurs after uterine amputation
The risk of complications after removal of the organ is minimal, but pain can be the first alarming symptom for a woman. First of all, the patient should pay attention to the localization of pain and its nature, as well as immediately contact a specialist for diagnosis.
The main cause of pain is soft tissue damage. Despite the fact that laparoscopy is performed without opening the abdominal cavity and removal of internal organs, the procedure still consists in amputation of the uterus. Tissue damage happens anyway. Even the most qualified surgeon will not be able to avoid this, because the uterus has a complex muscular structure. The first pain may appear in a few hours, when the anesthesia and painkillers are finally gone. By nature, it is mild, aching and long-lasting.
Another cause of unpleasant pain is nitrous oxide or carbon dioxide, which is used during the procedure to expand the boundaries of the abdomen.
Pain after removal of the uterus can occur from excessive stress or if the diet is not followed. As mentioned above, if a woman in the postoperative period abuses salty, spicy and smoked food, drinks alcohol and carbonated drinks, then intestinal motility is disturbed, which can cause constipation, which will put pressure on the injured tissue.
What to do if a selection appears after deletion
If there was a discharge after the removal of the uterus by the laparoscopic method, then in no case should you panic. In the postoperative period of discharge - this is a completely natural phenomenon, especially if they do not have a purulent smell, consist of a translucent liquid. This is an indication that the process of repairing damaged tissues. Let's look at the normal discharge and those that should cause anxiety in the patient.
- Norm. In the process of rehabilitation after removal of the uterus by the laparoscopic method of excretion, they should be slim and transparent. You can observe blood admixture. If there are no complications, the discharge appears within 3-4 weeks after amputation. At the same time, their number is gradually reduced to zero.
- Pathology. Blood clots, pus, unpleasant smell and heavy bleeding - this is the first signal that complications have appeared. An infection may have appeared, which may also cause irritation or itching. It should be noted that in the postoperative period often there is a thrush.
How to speed up the rehabilitation process
A woman should lead a correct life after removal of the uterus. The consequences for the body can be very unpredictable if the patient does not follow all the established rules:
- Council number 1. Refrain from junk food. In the first month after the operation, it is better to switch to cereals, soups and other lenten dishes.
- Council number 2. No alcohol, cigarettes or drugs. Chemicals only destroy tissues, and if they are damaged, the healing process slows down.
- Council number 3. Loads should be kept to a minimum. One trip to the store is broken several times so that the body does not feel the load. It is also better to stop going to the gym.
- Council number 4. Need to move. Do not run, do not jump, but take small walks in the fresh air, while trying in every possible way to avoid stress.
- Council number 5. Abstain from sexuality. After amputation of the uterus, tissues that need time to recover are injured. Having sex is better after consulting a personal gynecologist or another specialist.
- Council number 6. Life after the removal of the uterus continues!
At this point we will talk about the last advice above. Indeed, life continues after removal of the uterus, so a woman who agrees to an amputation must understand that in the future she will have to struggle with a certain psychological barrier. Consider them all:
- Removal of the organ can cause hormonal failure. In simple words, the uterus is a hollow "bag" for carrying a child who is not responsible for the production of hormones. Если по медицинским показателям хирург оставит яичники при удалении матки, последствия для организма будут минимальны.
- Это не полостная операция по удалению матки, поэтому шов на животе будет едва заметен. Женщина также сможет надевать бикини, красоваться на пляже и любить себя.
- After amputation, many can continue to live a full sexual life. The absence of a womb does not deny the fact that you are a woman.
- Yes, after amputation, the woman loses her reproductive ability, but it is worth noting that in many cases surgeons resort to alternative methods of treating pathologies to help the patient give birth to a healthy baby. Now women who are no longer able to give birth (from the age of 40 and above) are going to remove the organ to reduce the risk of cancer.
- Appearance will not change, because the appendages and ovaries will be in place. At the same time, on the background of stress, hormonal background can change, which can lead to deterioration of the skin, hair and nails.
The laparoscopic method gives women a new life. This procedure does not cause adhesions, such as abdominal amputation, which involves opening the abdominal cavity and removing the intestines. After this procedure, women rarely have psychological difficulties. After all, in appearance, one cannot say at all that any major surgical interventions were performed. This step in medicine prevents the development of cancer and allows women to live a full life. The main thing is not to ignore the alarming symptoms that can sometimes save the lives of us and our loved ones!
When is uterus removal indicated?
Direct indications for removal of the uterus are such cases:
- The presence of malignant tumors of the body and / or cervix. In this case, hysterectomy is the only effective treatment. If there are metastases, in addition to the operation to remove the reproductive organ, radiation and chemotherapy are required.
- Myomatosis Myoma is a neoplasm in a benign uterus. The disease can be expressed by the following symptoms: pain in the pelvis, heavy bleeding, anemia. In particularly advanced cases, removal of the uterus is the only possible treatment.
- Endometriosis. For some reason, the inner lining of the uterus begins to grow into the fallopian tubes, ovaries, and other organs of the peritoneum. If a course of conservative treatment and even surgery did not yield the expected results, a hysterectomy is prescribed.
- Abundant, constantly bleeding from the vagina. If the course of conservative treatment was ineffective, removal of the uterus may be the only way out.
When is laparoscopic hysterectomy contraindicated?
Despite the enormous advantages of the laparoscopic method of surgical intervention, there are a number of contraindications for use, namely:
- Prolapse of the reproductive organ (the uterus extends beyond the genital slit). The operation in this case is carried out only through vaginal access.
- The presence of ovarian cysts of large sizes.
- Significant size of the uterus (more than 20 weeks of pregnancy). This contraindication can be called relative, because an experienced surgeon can undertake laparoscopy in this case.
Based on the results of preliminary studies, the doctor decides on how much the operation will be to remove the uterus and in what way it is better to carry out. Today, there are such basic types:
- Removal of the reproductive organ above the vagina. During surgery, the body of the uterus is removed, while the cervix remains.
- Vaginal removal of the uterus assisted laparoscopically. In this case, the vessels and ligaments that feed the organ intersect through laparoscopic access, after which surgery continues through the vagina.
- Laparoscopic hysterectomy. Surgical intervention is carried out through laparoscopic access. Through the vagina, the organ is cut off and the vagina is sutured.
- General hysterectomy by laparoscopic method. In this case, the operation is carried out through laparoscopic access, including cutting off the genital organ and suturing the vagina.
- Radical removal of the uterus. The reproductive organ, together with the cervix, lymph nodes and the circulatory tissue, is removed through laparoscopic access. As a rule, such a radical operation is performed in case of oncology of the female genital organs (body and cervix, ovaries, endometrium).
The main advantages of laparoscopy
Removal of the uterus with the laparoscopic method is often used because of these advantages:
- Slight trauma. Surgical intervention is carried out through small incisions in the abdominal cavity. Due to this, the operation is more easily tolerated and there are practically no complications.
- Good cosmetic effect.
- Quick recovery period.
A good overview of the pelvic organs. The enlarged image is displayed on the screen, which allows the surgeon to see everything he does. This is very important if there is endometriosis, adhesions, cysts.
How is surgery performed to remove the uterus with a laparoscopic method?
Laparoscopic removal of the uterus is carried out without large incisions in the abdomen. Laparoscopic instruments and a video camera are inserted through small incisions into the abdominal cavity. The doctor carries out manipulations, and the course of the operation is displayed by the camera on the monitor screen. So that the doctor has the opportunity to see well what is happening, as well as access to the uterus, the abdominal cavity is filled with gas at the very beginning.
The laparoscopic method can be used in two versions, which will be discussed further in more detail.
- Vaginal hysterectomy assisted laparoscopically. In this case, the operation is carried out in combination of these two methods. First, laparoscopy is performed, the purpose of which is the separation of adhesions, excision of foci of endometriosis, removal of the ovaries and tubes of the uterus, the intersection of the upper portion of the ligament apparatus of the organ. After these manipulations, the doctor continues the operation through the vagina. Due to such a course of operation, injuries are reduced, the rehabilitation period will be easier, and there are fewer complications. In addition, a good cosmetic effect is achieved, because there will be only a few small scars on the stomach, which will eventually become imperceptible.
- Total laparoscopic hysterectomy. The essence of the operation is that the uterus is removed only by laparoscopic method. At the very beginning of the operation, the doctor makes incisions on the woman’s stomach. Using a cannula, fills the abdominal cavity with gas. Trocars are also inserted through incisions, and a camera and special instruments are inserted through them into the abdominal cavity. During the operation, the surgeon crosses the uterus. If necessary, crosses the ovaries and fallopian tubes, and also ligates the uterine arteries. To extract the removed fragments from the vagina, a small incision is made in the lower abdomen or in the vagina. If there is an oncological process, the removal of the reproductive organ is performed with nearby lymph nodes.
As a rule, laparoscopic operations are characterized by a low percentage of complications. In rare cases, accidental injuries to internal genital organs, blood vessels, exposure to gas that is introduced into the abdominal cavity, on the body, hematomas, and infections are possible.
How to prepare for the operation?
Before the operation, you need to pass a full examination. Only after receiving the results of the examination, the doctor can decide on the extent of the surgical intervention and the method of conducting
These types of examinations are prescribed:
- ultrasound (ultrasound of the pelvic organs),
- blood test (general, biochemical, for clotting, for hepatitis, blood group and rhesus, for immunodeficiency, for syphilis, for glucose),
- urinalysis (total, sugar content),
- analysis of vaginal smears,
In some cases, examination is also scheduled with other doctors, in particular, the therapist, cardiologist. The day before laparoscopy is not recommended to eat.
After the operation to remove the uterus with the laparoscopic method, the consequences will be minimal in most cases. A month after the operation, the woman will be able to return to the usual rhythm of life.
During the recovery period, heavy physical exertion is not recommended, especially on the abdominal muscles.
The first few days after laparoscopy, a woman may experience slight pulling pain in the lower abdomen. This is considered normal and should pass in a couple of days.
In rare cases, the formation of adhesions is possible, as a rule, with severe endometriosis or with a genetic predisposition.
Slight discharge from the vagina is also possible. If the ovaries are saved, they continue to produce hormones, so this phenomenon is considered normal.
It is rarely possible inflammatory processes in the genitals. This happens if a woman does not comply with the recommendations of the doctor, in particular, antibacterial treatment, the course of which is the first 5 days after the operation.
To avoid unpleasant consequences, you must follow the instructions of the doctor to adjust the water-electrolyte balance of blood.
The positive outcome of laparoscopic hysterectomy depends on the qualifications of the doctor. Only in this case, the effects of surgery will be minimal, and the recovery period is as easy as possible.
Women should not be afraid of removal of the uterus and ignore the doctor's prescriptions. Perhaps this is the only option not only to get rid of unpleasant symptoms, but also to save lives. And the doctor will select the most appropriate method of operation, taking into account all the factors individually in each case.
How much does a uterus surgery cost? The cheapest treatment will cost Israel.
Practice shows that the level of Israeli medicine is quite comparable with the world, and prices are 30-40% lower.
In general, the cost of the operation to remove the uterus in each case is calculated separately and strongly depends on the country, city, level of the clinic and the characteristics of your body. Of course, simple removal of the uterus will cost significantly less than extirpation — complete removal of the uterus, along with the appendages and ovaries.
Recovery and Rehabilitation
Postoperative therapy is aimed at restoring water and electrolyte balance and blood, as well as the prevention of inflammatory processes.
It is necessary to pay attention to the psychological aspect: any operation is stress, and the operation in the gynecological field is a very serious shock for any woman.
The sick-list after uterus removal is usually given for a period of 25 to 45 days. Some women tolerate surgery very easily and go to work after 3 weeks.
In the diet after the removal of the uterus, a woman must necessarily adhere to a sparing diet: no aggressive or irritating mucous products. From the diet should be excluded: confectionery, coffee and strong tea, cottage cheese, chocolate, white bread.
To "start" the work of the intestine after surgery, you need to eat a little, but often - 5-7 times a day. The daily rate of water consumption should be increased to 2-4 liters. It is necessary to use products that have a debilitating effect:
porridge, broth, fermented milk products.
The basic rule is to strictly adhere to the diet prescribed by the attending physician, both in the first days upon completion of the operation, and after discharge.
During the rehabilitation period after removal of the uterus, the load must be feasible, it is impossible to lift a weight of more than 5 kg.
Of course, you need to perform any kind of physical exercise only after the incisions are completely healed, otherwise the stitches may disperse from excessive efforts. It is reasonable to consult with your doctor, he will tell you what gymnastics after the removal of the uterus will be optimal for you.
By the way, many doctors advise getting up and even walking slowly in the first days after surgery. Such moderate exercise will prevent blood from stagnating in the organs, and the healing process will go faster.
Pain after removal of the uterus can be observed due to the formation of adhesions or bleeding. These symptoms often appear in the first time after surgery. Also, the consequences of the operation can be deep vein thrombosis of the lower legs, various urinary disorders, suture suppuration, hematomas. All these complications significantly prolong the recovery process. Often in women after the removal of the uterus, all the symptoms of menopause occur. It is also possible to reduce the level of sexual desire and the appearance of dryness in the vagina, but such complications are the exception rather than the rule. Patients after removal of the uterus become more susceptible to diseases such as osteoporosis and atherosclerosis.
Discharge after uterus removal
After removal of the uterus, bleeding is possible, as ovarian function is not affected, and sex hormones affect the cervix. In this case, the main thing is that there is no increased secretion.
If there are any concerns, do not wait for everything to go by itself. Be sure to consult your doctor for a survey and a correct diagnosis.
If you have any concerns, immediately contact your doctor.
In the following cases, mandatory notification of the attending physician is necessary:
There is an unpleasant odor, nausea, fluid incontinence, the presence of large clots in the discharge, the need for multiple changes of gaskets for an hour and the presence of bright red blood discharge from the vagina.
HRT - hormone replacement therapy - is necessary after the removal of the uterus and ovaries, because the body loses the ability to produce hormones on its own without ovaries. So hormone therapy after removal of the uterus is recommended for all women, regardless of age. In fact, this is a replacement for ovarian function lost as a result of the operation.
In HRT are used:
progestin, estrogen, androgen and sometimes.
For the use of hormonal drugs after removal of the uterus, there are a number of contraindications that are found out during a comprehensive gynecological examination.
The services of Israeli and German doctors enjoy the highest reputation.
Basically, the operation in most women is successful and without complications. In addition, foreign clinics carry out postoperative monitoring of their patients. So the doctor will be able to notice in time if something goes wrong.
To identify diseases in the early stages and diagnose susceptibility to them, it is desirable to regularly complete a comprehensive examination of the body.
In our article on the link you will find out what is included in the survey, where it is better to go and how much it costs.
You can find more information on this topic in the Gynecology section.
Uterine fibroids is considered the most common benign tumor of the female genital.
There are a lot of methods for treating such a disease, but surgical techniques are considered to be the most effective. One of the popular tactics of myoma treatment is laparoscopic surgery.
Even in the recent past, myoma tumors were removed only through open surgery, which caused many complications such as internal bleeding, the occurrence of adhesive processes and loss of reproduction.
To date, the laparoscopic technique is considered the best alternative therapeutic solution in relation to open abdominal surgery. Moreover, after laparoscopy, which helps to successfully remove myomatous formations, there are no traces left.
The procedure is carried out with the use of special tools that gets to myomas through small abdominal punctures. A special video camera is used to visualize what is happening in the course of surgery.
Indications and contraindications
Laparoscopic surgery for uterine fibroids is not always applicable. There is a list of specific indications for such an intervention. Namely:
Multiple or single fibroids with nodes 30-60 mm, rapid progression and growth of the tumor, when the formation prevents conception or bearing of the fetus anemia caused by heavy bleeding, poor circulation in the node, due to twisted legs or other causes.
Far from every patient is allowed to undergo laparoscopic removal of myoma tumors.
Thus, it is forbidden to remove myoma in a similar way to women who have:
Problems with the digestive system, liver pathology, Hemophilia or hemorrhagic diathesis, Cardiovascular or respiratory pathologies, Suspected knot malignancy, Too many nodes located in the thickness of the uterine wall.
In addition, laparoscopic removal of myomas is contraindicated in the presence of a hernial process in the peritoneum, insufficient or overweight, ovarian or cervical oncology, large sizes of nodes (more than 12 weeks).
Types of laparoscopic surgery to remove uterine fibroids
Лапароскопическая операция может носить консервативный либо радикальный характер.
При консервативной лапароскопии осуществляется удаление узлов, т. е. проводится миомэктомия. If the patient shows radical laparoscopy, then in the process of such an operation, the uterine body is removed completely, that is, a hysterectomy is performed.
Removal of the uterus with preservation of the ovaries ensures complete loss of menstrual function, however, the appendages continue to function and fully produce hormones. That is why the climacteric period comes on time and the patient has no adverse reactions that are traditionally observed during the removal of the ovaries.
Even with such safe removal of myomas, like laparoscopy, there is a possibility of postoperative complications.
In general, all complications are divided into 2 classes:
Arising from any laparoscopic interventions or common, Characteristic only for myoma formations or specific.
Among the common complications can be distinguished vascular injury or intraorganic damage caused by the introduction of devices. In addition, complications can be caused by anesthesia, respiratory problems, uterine hematomas, defects due to improper stitching, or infectious complications.
As for specific complications, they may consist of uterine or myoma hemorrhages, hernial processes in the peritoneum, etc. In addition, for the first two or three days, the patient will be bothered by nagging pains in the lower abdominal wall.
If the nodes of myoma were located low or were of an interstitial nature, then in the process of laparoscopy, intestinal, urinary bladder structures or ureters may suffer.
Diet after laparoscopy
Laparoscopic removal of uterine fibroids does not impose strict dietary restrictions in the postoperative period, however, some restrictions must still be adhered to.
Food should ensure the smooth functioning of the intestinal structures so that there are no constipation, which can provoke peritoneal strain and divergence of uterine sutures.
In addition to intestinal functionality, the principles of proper nutrition allow you to bring body weight to normal levels, as well as help cleanse the body of slagging.
In other words, rational nutrition allows you to eliminate several factors that provoke the occurrence of myomatous processes.
The price parameters of laparoscopic removal of uterine myomatous formations vary significantly depending on the status of the medical center, its geography, the surgeon's qualifications and other factors.
On average, laparoscopic surgery will cost 17 000-90 000 ₽. If we talk about foreign clinics, the price of such an operation in the USA is 6,000 euros, in Germany and Israel about 7,500 euros.
In general, patient reviews regarding laparoscopic methods of removing uterine myoma nodes are positive, due to the minimal risk of complications, the absence of pain in the postoperative period and the short rehabilitation period, the absence of cosmetic defects after surgery.
Removed myoma, quite large, from several nodes. The doctor recommended laparoscopy. At first she was afraid, she thought for a long time, but after studying a lot of reviews regarding laparoscopy, she decided on an operation. Doctors worked clean, removed 3 nodes. It has been almost 2.5 years, I do not remember about myoma. The last survey took place 2 months ago - everything is clean. Therefore, do not be afraid of the operation.
I was diagnosed with myoma, for her treatment the doctor suggested laparoscopy. I was satisfied that the complications were minimal, the rehabilitation was short, and there were no traces after the intervention, so I did not think for a long time, I agreed. However, after six months it turned out that not all the nodes were removed, so a repeated laparoscopic operation was needed. There were no complications, however, but because of such a medical error, the impression of the operation is not entirely positive. Although, in general, the punctures healed quickly, and there was no pain after the operation. So, pulled a little, as before menstruation, and all.
The laparoscopic method of treating myoma formations among patients is considered more acceptable because it is cheaper than other procedures such as FUS ablation or embolization, and the risk of relapse is minimal.
The video shows the course of laparoscopic myomectomy in uterine myoma:
Leiomyoma, fibroids or fibroids (fibrosis) of the uterus is a benign growth that occurs in the myometrium (muscle layer) of the organ. This is the most common disease of women after 45 years, however, the doctor will never prescribe a surgery without a serious reason. A small tumor is treated with conservative methods, but sometimes it is impossible to do without surgery. If uterine fibroids are determined at a young age, then gynecologists especially try to keep the woman's reproductive function.
In modern medicine, the operation to remove the uterus in the presence of myoma formations is prescribed for the following pathologies:
- the tumor is localized on the neck of the organ,
- fibromatous nodes exert pressure on adjacent tissues and organs, which causes constant pain in the patient,
- there is a risk of reincarnation of a benign tumor in cancer,
- signs that the fibroids on the leg with time will occur torsion, and this will lead to necrosis,
- the development of fibroids occurs with the prolapse of the uterus or the prolapse of the genital organ,
- the tumor has vivid clinical manifestations, and the woman is in menopause,
- fibromyoma has reached sizes greater than 12 weeks of gestation.
Chronic growth of the endometrium (glandular tissue) outside the uterus is called endometriosis. Pathology also refers to the common, and may be inside the reproductive system or outside it. The vast majority of diseases accounted for by the internal course of the disease. Laparoscopic removal of overgrown epithelium is mainly used, which preserves the uterus and other organs. If there is an aggressive course of the disease, a persistent lack of results of drug treatment or the risk of malignant degeneration, then doctors may insist on a hysterectomy.
Cervical or Ovarian Cancer
Removal of the uterus in cancer saves the patient's life. As a rule, in oncology, in addition to surgery, radiotherapy or chemotherapy is also prescribed. In cancer, radical hysterectomy is recommended, that is, not only the uterus is removed, but also the cervix, ovaries, upper vagina, fallopian tubes, and tissues with lymph nodes in this area are removed. The early stage of oncology allows you to perform a more benign operation with preserving the woman's reproductive function: removing 2/3 of the cervix with preserving the internal pharynx and other organs so that you can become pregnant and give birth.
Necrosis of fibromatous nodes
The most serious complication of uterine fibroids is necrosis of the fibromatous node. The disease is a violation of the nutrition of its tissues, in which there is swelling and sharp pain. On palpation of the node pain increases, vomiting, irritation of the peritoneum, the temperature rises. In the case of the addition of an infection, the general phenomena are intensified. The indication for surgery is to establish a diagnosis. The volume of the operation is decided individually, depending on the age and general condition of the patient.
Prolapse or prolapse of the uterus
The prolapse or prolapse of the genitals in a woman occurs when the pelvic or peritoneal muscles are weakened. Pathology develops due to hard work, multiple births, endocrine disorders, or chronic inflammation. At the initial stage of the disease, therapy is aimed at strengthening weak muscle groups. Hysterectomy is considered though the most radical, but the most effective way to solve the problem. There are two options: excision of the uterus and the upper part of the vagina or the partial removal of the vagina, which preserves the possibility of sexual activity.
Before carrying out hysterectomy, gynecological and general examination of the patient is carried out. Laboratory diagnostics includes the conduct of biochemical and clinical blood tests for:
- HIV antibodies
- sexually transmitted diseases (chlamydia, syphilis),
- infectious hepatitis,
- hormone levels, minerals, sugar,
- blood clotting
- rhesus factor and group.
Also conducted ECG, spirography, tonometry, radiography of the lungs. In identifying pathologies of the nervous system, kidney, respiratory system or heart, the patient is sent for additional examination to other specialists. Gynecological diagnosis includes examination of the vagina and uterus, pelvic ultrasound. If you suspect cancer, a woman is sent for MRI, biopsy and histology. It is important before timely removal of the uterus to identify infections in the urinary and genital tracts.
If a woman does not have infections and pathologies of other organs, then she does not need medical preparation before removing the uterus. Infections are treated, and antibacterial drugs are prescribed for the following diseases:
- cold and viral infections
- endocrine pathologies (diabetes),
- neurological diseases
- disorders in the kidneys, respiratory system, cardiovascular system.
An extremely important manipulation before the operation is the preparation of the veins. Even if there is no varicose disease or chronic thrombophlebitis, after surgery, there may be stagnation in the blood due to increased venous pressure. Such a process can end with severe complications up to the separation of the thrombus and its entry into the brain or lung vessels. Before the operation to remove the uterus, the patient should always consult a phlebologist or a vascular surgeon. During hysterectomy, a compression is created for the veins using elastic bandages.
Recovery after surgery is a long process, and removing any uterus for any woman is stressful. The younger the patient, the greater her psychological trauma. The role of the doctor in this case is to explain the need for such an intervention, why it cannot be avoided, to tell about the course of the operation and the chosen excision option.
Many women fear that after removal of the uterus, they will have problems with their partner or their sexual function will be completely lost. Practice shows that after rehabilitation a woman loses only the function of childbearing, and she continues to experience sexual desire. For reasons of medical ethics, the doctor will advise not to inform the man about the extent of the removal of the uterus.
Course of operation
How is the surgery to remove the uterus? Hysterectomy begins with the surgeon choosing the volume and access. As already mentioned, either the entire uterus with appendages is removed, or only part of it. Depending on the operative access, the following types of hysterectomy are distinguished:
- Removal of the uterus through the vagina.
- Supravaginal (subtotal).
- Laparascopic with tools.
- Laparoscopic robot da Vinci.
- Open removal (abdominal surgery).
Surgical intervention to remove the uterus with the introduction of anesthesia begins. Anesthesia is applied, depending on the woman’s body weight, age, general health and the duration of the operation. All patients are introduced into general anesthesia, regardless of the chosen intervention technique for complete relaxation of the muscles of the abdominal wall.
The most benign type of removal of the uterus is laparoscopic surgery. An intervention is performed without incisions in the abdomen - the doctor uses special tools for puncturing. First, a cannula (tube) is inserted into the abdominal cavity through which the gas passes. This is necessary in order to raise the abdominal wall, and the surgeon has free access to the uterus. Further tubes are used, which are inserted into the abdominal cavity through punctures, and then through them the video camera and the surgical instruments that are removed are lowered. The advantage of the method is small incisions, a faster postoperative period.
The main feature of the vaginal hysterectomy is that it is carried out in a way that is convenient for the woman - after the operation there are no scars or stitches on the body at all. After vaginal removal of the uterus, the patient recovers quickly, and a quick emotional rehabilitation takes place. Unfortunately, only a third of patients operate in this way, since there are many contraindications:
- large size of the uterus,
- cesarean section,
- malignant tumors,
- combined pathologies,
- acute inflammation of other organs and systems.
How long does the operation to remove the uterus? The duration of laparoscopic hysterectomy is on average 1.5 - 3.5 hours. Abdominal removal of the uterus lasts from 40 minutes to 2 hours, depending on the complexity of the surgical procedure. The duration of vaginal hysterectomy is no more than two hours, if the procedure passes without complications.
Any surgical intervention is a different degree of injury caused by damage to the tissues and blood vessels. After removal of the uterus, it takes time to fully restore the body. The scheme and duration of rehabilitation measures always depends on the severity of the disease, the characteristics of the female body, the type of operation, and postoperative complications. For the correction of health in the postoperative period, a whole complex of rehabilitation measures has been developed. Its main components are physiotherapy exercises, proper nutrition, and hormonal support.
Nutrition after surgery
After the surgery to remove the uterus should follow the recommendations aimed at improving the gastrointestinal tract:
- Eat at least 6-7 meals in small portions.
- Drink two liters of plain water every day.
- Food consumed in liquid or semi-liquid state.
It is necessary to introduce porridge in a crumbly form into the diet, and sea fish and lean meat - only in boiled one. Meat broths, low-fat fermented milk products, vegetables (beans, potatoes and cabbage - carefully), vegetable salads with vegetable oil, vegetable purees are allowed to eat. Fresh greens, dried fruits, walnuts are recommended. You can drink pomegranate juice, green tea.
- liquid porridges,
- muffin, white bread,
- fried, fatty, spicy dishes,
- semi-finished products
- smoked meats
- black tea, coffee,
- carbonated drinks,
- limit salt intake to prevent fluid retention.
Recommendations of doctors in the postoperative period
Conducting a hysterectomy changes the lifestyle of a woman. To successfully recover from the removal of the uterus, doctors recommend paying attention to the following points:
- Bandage. Especially recommended for menopausal patients with multiple births.
- Sex. For 4-6 weeks, sexual life is prohibited, because during this period the discharge continues.
- Special exercises. There is a perinealmeter - a special simulator for strengthening the muscles of the pelvic floor and vagina. It ensures the effectiveness of intimate gymnastics.
- Tampons As long as there are excretions, use gaskets. Tampons are allowed only 2-2.5 months after removal of the uterus.
- Nutrition. Healthy food is important. Most of the dishes should be consumed before 16 o'clock in the afternoon.
- Hospital. The disability period is 30-45 days for hysterectomy. In case of complications, the sick leave is extended.
Possible postoperative complications and consequences
Rarely, there are complications after surgery to remove the uterus, but in order to seek help in time, you need to know about them. In the first days after hysterectomy, the following deterioration is possible:
- seam divergence or scar inflammation with purulent discharge,
- difficulty urinating (cramps, pain) or urinary incontinence,
- different intensity of bleeding (internal or external),
- pulmonary arterial thrombosis or thromboembolism leading to blockage of the branches, which is fatal,
- inflammation of the peritoneum (peritonitis), which can provoke sepsis,
- hematomas in the suture area,
- discharge with foul odor and clots.
If a seam infection occurs, then the patient's temperature rises to 38 degrees. To relieve this complication, the appointment of antibiotics is enough. Peritonitis develops more often if an emergency hysterectomy is performed on the woman. In this case, the pain syndrome is pronounced, therefore, antibiotic therapy and infusion of colloidal solutions are carried out. Repeat surgery may be required to remove the uterine stump and flush the abdominal cavity with antiseptics.
In the following months, there is a menopause, which in this situation is difficult. Most women feel burning and dryness in the vagina, hot flashes, discomfort in the genital area, anxiety. This is due to hormonal adjustment, when the female body stops producing estrogens, as a result of which the vaginal mucosa becomes thinner and loses lubricant. Sexual intercourse in this condition can be painful, so the woman's desire for sex decreases.
Cost of operation
How much does a uterus surgery cost? Цена гистерэктомии зависит от нескольких факторов: уровня больницы, профессионализма хирурга, масштабности операции, региона и продолжительности пребывания в стационаре. Также на стоимость операции влияет способ оперативного вмешательства.In private clinics in Moscow, laparoscopy will cost from 16 to 90 thousand rubles. Conducting abdominal or vaginal hysterectomy will cost from 20 to 80 thousand rubles. A similar operation to remove the uterus in Israel will cost from 12 thousand dollars.
Natalia, 35 years old: Separation from organs is sad, but when a hysterectomy is the only chance for survival, then there is no need to choose. I had a benign fibroid for 12 weeks, but while I was collecting the documents, it grew to 20 weeks! Passed lane operation. I was not afraid of her, but waited as a rescue, because I thought that I would not survive - the bleeding during menstruation was so strong. He did the best surgeon in Ryazan, so there was only a thin shovchik.
Victoria, 46 years old: There are many women on the forum who have their uterus removed, and many speak about the operation, not as a big problem, but as a release from it. The only drawback, according to women, is the impossibility of having a baby, but at my age it is no longer relevant, so I easily agreed to undergo laparoscopy. The operation is simple - after 5 days was already at home. It has been 30 days, and I almost forgot that I had suffered a uterus removal. Only early menopause with gentle but frequent tides reminds of itself.
Larisa, 52 years old: After removal of the uterus, osteoporosis of the hip joints developed. The decrease in bone density over time leads to their fragility, so I constantly sit on supportive medications containing calcium and vitamin D. Doctors say that there have been changes in posture, although so far I have not seen it visually. To prevent the occurrence of complications, hormone therapy was also prescribed.
Uterine fibroids - an unpleasant disease, accompanied by vivid symptoms and provoking quite serious complications.
However, you should not despair from such a diagnosis - it was previously a fibroid was considered a precancerous condition, and the woman was removed with her reproductive organ.
Now medicine has advanced far ahead, and myoma is successfully treated not only by surgical methods, but also conservatively (with early diagnosis).
Moreover, surgical methods do not always imply abdominal surgery, minimally invasive interventions are possible, one of which is laparoscopy.
The causes of fibroids
To provoke the development of fibroids can as a series factors:
- hormonal disbalance. Myomatous formation develops with an imbalance of progesterone and estrogen. This phenomenon can occur when there is a disruption in the ovaries,
- unhealthy diet. With a large number of fatty and sweet foods in the diet, there may be a failure in the hormonal system,
- gynecological interventions - abortions, scraping, installation of a spiral, difficult childbirth, surgical operations - all this can lead to the formation of microcracks on the uterine walls, which are later covered by connective and muscular tissues, which is the basis for the development of nodular education,
- lack of sex and orgasms lead to stagnation in the pelvis, which is also the impetus for the appearance of fibroids,
- endocrine diseases
- genetic predisposition,
- excess weight,
- sedentary lifestyle,
- heavy exercise
What is laparoscopy
Laparoscopy is one of the most common and effective treatments for fibroids of large sizes.
Laparoscopy is a modern technique that has virtually no contraindications and allows you to get rid of fibroids in a short time. As a rule, it is an organ-preserving operation in which the reproductive organ is not subject to removal.
With this operation, conduct:
- removal of the uterus without the cervix,
- conservative myomectomy - only the node is removed,
- complete removal of the uterus and cervix.
Laparoscopy is not only a manipulation for therapeutic purposes, it is also carried out by specialists to diagnose a disease of the internal organs.
Removal of uterine fibroids by laparoscopic method is performed under general anesthesia, while using a special equipment, the surgeon removes the pathological formation from the uterus without affecting the work of the reproductive organ itself.
Indications for this operation
Laparoscopic surgery for removal of fibroids is carried out with due regard for the age of the patient, the state of her reproductive organs, and the presence of background illnesses.
Laparoscopy for uterine myoma is indicated for:
- severe pain and bleeding caused by myoma,
- rapidly growing education,
- strong pressure of fibroids on the surrounding organs,
- infertility and miscarriage,
- multiple nodules
- atypical structure of nodes.
In all other cases, it is preferable to prescribe conservative treatment, which will stop the growth of education.
Advantages and disadvantages
Patients among the advantages of laparoscopy are:
- minimal physical damage
- short rehabilitation period.
Doctors add the following:
- Fetal women, this operation allows you to save the reproductive organ,
- lack of massive bleeding,
- minimal risk of complications,
- lack of adhesions,
- patient's discharge is made on the 4th day,
- low incidence of disease recurrence.
In fairness, the shortcomings of laparoscopic intervention should be noted:
- maybe not in all cases
- difficulty in choosing a qualified surgeon.
Types of laparoscopic methods
With the help of laparoscopy, you can directly remove the myoma node (conservative method), and you can remove the entire uterus (radical method).
The conservative method is recommended for women who are subsequently planning a pregnancy.
The radical method is most often prescribed for menopausal women, as well as for very large fibroids.
Recovery after radical laparoscopy is significantly different from rehabilitation in the postoperative period after conservative removal of the neoplasm.
What are the possible complications?
Despite its minimally invasive, laparoscopy is still a surgical intervention, and, therefore, after it some complications are possible.
They make up only 2% of cases, but it is impossible not to say about them:
- mechanical damage to the organs is possible with lapaproscope instruments or with the introduction of gas into the abdominal cavity,
- vessels at a puncture can be injured,
- internal bleeding may occur,
- mechanical injuries of the intestine or urinary tract are not excluded,
- In some cases, carbon dioxide can penetrate into the subcutaneous fatty tissue.
Are there any contraindications
Contraindications for laparoscopy are the following:
- malignant processes in the mammary glands or pelvic organs,
- inflammatory processes
- the presence of infectious diseases
- extensive adhesions in the abdominal cavity,
- skin diseases that have the potential for infection to enter the body,
- atypical reaction to anesthesia,
- bronchopulmonary diseases
- severe kidney ailments
- severe damage to blood vessels and the heart, severe hypertension.
A few hours after surgery, a woman can get up and move. The movement is necessary so that adhesions do not form, the remaining gas is withdrawn more quickly and the rehabilitation process takes place more easily.
There are no special restrictions in nutrition, but it is better to use food fractional. It is recommended to wear compression stockings and bandage.
The stitches after the operation are removed after about a week, after three weeks active physical activity is resolved, and after a month you can live a sex life.
As for pregnancy planning, it depends on the severity of the operation, the number of nodes and other factors. But in any case, conception is worth thinking about no earlier than after 6-12 months.
In the first few days after laparoscopy, pains are possible, which are eliminated by painkillers, therefore, it is better for a woman to stay in the hospital for 3-4 days after the operation under the supervision of doctors.
If the reproductive function is preserved, the doctor will surely explain when your period should begin approximately, and warn you about mandatory contraception in the first six months or a year. Also, the doctor will tell you about the lifestyle for the next month.
The following are real reviews of women who underwent laparoscopy:
For a long time it was believed that the only way to get rid of fibroids is hysterectomy, that is, the removal of the uterus. With this, of course, you can not argue - the method is effective. However, it is completely unacceptable for young patients who have not yet fulfilled their main female mission and wish to have offspring. Fortunately, for those women who, for one reason or another, need to preserve the genital organ, there is an alternative treatment option - laparoscopy of uterine fibroids.
Today, according to leading Russian gynecologists, there is no such fibroids, in which hysterectomy would be a mandatory operation. Removal of uterine fibroids by a laparoscopic method with preservation of the reproductive organ is the gold standard of surgical treatment, and the feedback from patients who have undergone this type of surgery is overwhelmingly positive.
Benefits of laparoscopic surgery
Before the introduction of laparoscopic equipment into gynecological practice, physicians could also preserve the uterus by removing only myoma nodes. But at the same time, abdominal surgery was performed - laparotomy, that is, a scalpel was used to make an incision in the anterior abdominal wall about 15 cm long, through which the tumor was removed. After such an operation, a scar remained on the skin of the abdomen, which caused a lot of distress to the representatives of the beautiful half of humanity.
Needless to say, such cuts caused women not only cosmetic troubles, but also healed for a very long time after the operation, and also caused long-term rehabilitation of the patients.
The laparotomy operation, in which an incision is made in the anterior abdominal wall, is quite painful during the rehabilitation period and is often associated with various complications, including bleeding and inflammatory processes.
So, the main advantages of the laparoscopic technique, compared with laparotomy, are:
- Cosmetic - postoperative scars are almost invisible,
- Less surgery injury
- The bloodlessness of the procedure or minimal blood loss,
- No need for a long hospital stay,
- Rapid recovery and return to active lifestyle,
- Reduction of postoperative pain,
- Improving the quality of life of patients
- Reducing the amount of drug therapy in the postoperative period,
- Less risk of formation of adhesions.
Indications for laparoscopy
Conservative myomectomy is performed laparoscopically in the following cases:
- Uterine fibroids up to 12–15 weeks in women of child-bearing age,
- When uterine fibroids are the only cause of infertility and (or) miscarriage,
- Severe anemia in a woman due to uterine bleeding, the cause of which is uterine fibroids,
- Severe pain due to malnutrition
- Rapid tumor growth,
- Activation of fibroids after menopause,
- Disruption of the normal operation of the organs adjacent to the uterus (ureters, bladder and intestines).
Laparoscopic method of removal of fibroids is used, including, with the rapid growth of tumors.
How to prepare for surgery
As with any other planned surgery, it is necessary to undergo an examination, which includes:
- Blood tests - clinical, biochemical, detection of indicators of the coagulation system, screening for hepatitis B and C, HIV infection and syphilis, as well as determination of blood group and Rh factor,
- General urine analysis,
- Gynecological ultrasound,
- Smear on the definition of vaginal microflora and cytology,
- The conclusion of the dentist about the absence of caries,
- The conclusion of the therapist about the absence of chronic diseases, which may be aggravated during the operation,
- Consultation with a doctor who will conduct anesthesia.
Among the examinations that must be completed in preparation for laparoscopic myomectomy is a smear on flora and cytology.
Preparation for laparoscopic tumor removal includes the following points:
- A few days before the operation, exclude products that cause increased gas formation,
- On the eve of the procedure, a light dinner is allowed no later than 18 hours,
- In the evening and in the morning, the bowels are cleansed,
- Food and liquids are prohibited on the day of surgery.
For the prevention of thromboembolic complications before surgery, elastic bandaging of the lower extremities or the use of compression hosiery (anti-varicose stockings) is necessary.
How the operation is performed
Removal of uterine fibroids by laparoscopic method is always carried out in a gynecological clinic or hospital in a sterile operating room.
Routine surgery is usually performed in the morning or in the morning and lasts from 30 minutes to two hours, depending on the volume of the operation and the size of the tumor.
For laparoscopic manipulation, any day of the cycle is suitable, except for the period of menstruation. During menstruation, increased bleeding is noted, so the risk of bleeding increases during surgical procedures.
Anesthesia - endotracheal with the use of mechanical ventilation. The patient sleeps, hears nothing, does not see and does not feel pain.
Before the operation, combined anesthesia is used - endotracheal anesthesia, which helps to transfer the whole process of surgery without pain and stress.
Before the operation, the woman signs an informed consent, thereby confirming that the doctor explained to her how the fibroids will be removed and about the possible change in the volume of the operation if complications arise. In the event of unforeseen developments, surgery may result in the removal of the uterus, which the doctor also warns about before the operation.
What happens in the operating room
- The patient is placed on the operating table. After treating the skin of the abdomen, the surgical field is surrounded by sterile sheets,
- After acting anesthesia, punctures are made at the navel and on the sides of the abdomen in the iliac regions, through which endoscopic instruments are inserted,
- For a better view of the uterus, carbon dioxide is injected into the abdominal cavity, which is completely harmless to the body. Intestinal loops move from the small pelvis to the upper floor of the abdomen and do not create obstacles to the operation,
- The surgeon examines the uterus, appendages, nodes fibroids. The image of what is happening in the abdominal cavity of the patient is transmitted to the monitor screen. During the operation, the doctor does not touch the pelvic organs with his hands.
Stages of operation
- Cutting off a fibroid site (if it has a leg) or treating a tumor located in the muscle wall of the uterus. To do this, an incision is made on the surface of the capsule, the node is fixed with two clips and is removed by successive stretching. For myomatous nodes is characterized by the presence of a clearly defined capsule, so that they are easily husked without additional trauma to the uterine wall. The tumor bed (the place where it was located) is washed with a saline solution, and then the bleeding areas are carefully coagulated,
The process of myomectomy begins with clipping or expelling the tumor.
- Closure of the uterine muscle wall defect. The defect of myometrium formed after removal of the tumor must be sutured. The surgeon also does this manipulation, not touching the organ with his hands, but only looking at the screen and using the tools inserted into the abdominal cavity of the woman. The imposition of an endoscopic suture is the longest and most laborious stage of the operation. The suture must be reliable so as not to create a threat of uterine rupture in this place in subsequent births. This requires some experience from the surgeon,
- Removal of fibroids from the abdominal cavity. Small myoma nodes can be freely removed through the existing incisions in the abdominal wall. Extraction of large assemblies will require the use of a special tool - an electromoillator, which with the help of a system of rotating knives, first crushes and then “sucks” the parts of the tumor, like a vacuum cleaner. This removes large fibroids,
- Revision and rehabilitation of the abdominal cavity - the final stage. At the end of the operation, the surgeon once again examines the abdominal cavity, removes accumulated blood clots, checks the viability of stitches on the uterus, carries out hemostasis of small bleeding vessels and removes instruments. The total volume of blood loss during surgery is not more than 50 ml,
- To prevent the formation of adhesions, a special anti-adhesion mesh is used, which is absorbed after 14 days and does not allow the intestine or omentum to be soldered to the postoperative scar,
- Intradermal cosmetic sutures are applied to the puncture site, which self-dissolve within 2-3 months and then become pale and inconspicuous,
After laparoscopy, punctures are sutured subcutaneously, and cosmetic seams are applied to the skin.
Ход лапароскопической операции записывается на видео, и каждая пациентка имеет видеопротокол.
After laparoscopy of uterine fibroids, the woman recovers very quickly and returns to her normal lifestyle. With a favorable postoperative course, a woman is discharged from the hospital home for the 2-3rd day after surgery. In the case of complications that are rare, there is a need to stay in hospital for up to 7 days.
The sick-list is usually given for 7-14 days. If a woman’s work is not associated with hard physical labor, she can take up her duties, if she wishes, on the 4th day after the operation. The temporary incapacity sheet can be extended if necessary (for example, if complications have arisen or with poor general well-being).
Full rehabilitation occurs in 15-30 days.
Monthly after surgery usually begins after 28-30 days, but their delay is not a reason for panic. This may be due to a postponed operation. Surgery is stressful for the body and can cause menstrual failure. Intermenstrual discharge is also allowed.
After surgery, possible intermenstrual discharge is considered the norm.
Physiotherapy during the rehabilitation period is not a mandatory procedure and is prescribed at the discretion of the physician to prevent adhesions or inflammation.
Within six months after surgery, the woman is under dynamic observation by a gynecologist. She should be examined and for an ultrasound scan 1, 3 and 6 months after laparoscopy of the fibroids.
Until complete healing of scars on the uterus (and it will take 3-6 months), hormonal contraception is prescribed. The choice of a suitable drug is carried out by a doctor depending on the state of the female reproductive system.
6 months after the control examination and ultrasound, when the doctor is confident in the viability of the uterine scar, the patient is allowed to plan pregnancy.
After laparoscopic myomectomy, childbirth is possible both through the birth canal and by cesarean section. The mode of delivery is determined by the doctor based on obstetric indications.
During the rehabilitation period of 1 month it is recommended:
- Wear a bandage to reduce the load on the anterior abdominal wall,
- Limit weight lifting and exercise,
- Refrain from sexual intercourse,
- Follow a diet and organize proper nutrition - eliminate fatty foods from the diet, foods that cause bloating and increased gas formation (legumes, fresh vegetables and fruits), because they can cause stomach pain and diarrhea,
- Postpone exercise for up to 4-6 months to ensure full healing of the uterine scar.
To reduce the load on the abdominal wall during the rehabilitation period, it is desirable to wear a postoperative bandage.
“My story, like the stories of millions of women, is too banal. At the age of 31, I was diagnosed with a multiple uterine myoma of up to 18 weeks gestation (an ultrasound scan showed the presence of six myomatous nodes of various sizes). And the fibroid was symptomatic: pressed on the bladder, back was aching.
I will say right away - I decided to fight for the womb to the end. Although I already had a son of 10 years old, I really wanted to give birth to someone else for the kit. Moreover, there was no desire to "get stuck" in hospitals for a long time and writhe from pain in the postoperative period.
Operated me in the medical center endoscopy. The team is wonderful! Everything went "like a note." Before the operation, I read a lot of sources from the Internet. So, in my case, everything was as it was described: early activation, no antibiotics and at least anesthetics (they were anesthetized once a night). It even seemed to me that I had more pain and a sore throat from the anesthetic tube than the uterus.
4 hours after the operation they were allowed to eat light liquid food. I took with me yogurt without additives, baby fruit puree and oatmeal in bags.
On the 2nd day in the evening my husband and son took me home. And after 5 days I went to work. The state of health was wonderful.
Half a year has passed. From the huge fibroids on the ultrasound is not a trace. My doctor has allowed me to plan a pregnancy. Today I made a pregnancy test - two cherished stripes! In the evening I will please my husband!
Dear women! If you need surgery, and you need to preserve the uterus for subsequent labor, decide on laparoscopic removal of fibroids without fear and doubt. Everything will be fine - like mine! "
Veronika, 32 years old, Moscow
Today, laparoscopic intervention is the most advanced operation. And perhaps it will help you to get rid of uterine fibroids without ugly scars and scars, without pain and big blood loss, and then - safely carry and give birth to the baby.