Laparoscopy for polycystic ovarian disease - the essence of the operation and reviews of women
This disease can occur for various reasons - due to stress, hormonal failure, and even when changing climatic conditions. Laparoscopy as a method of treating ovarian cysts has many advantages, which include the ease of operation and the rapid recovery of the patient's body.
What is polycystic ovary
A common hormonal disorder in women who have not yet emerged from childbearing age is called polycystic ovary syndrome (PCOS). It is characterized by the development of many small cysts - follicles filled with fluid.
They contain undeveloped eggs, which are located along the shell of each ovary. The consequence of this may be a failure of the menstrual cycle, problems with pregnancy, the appearance of cysts in the genitals.
Experts associate polycystic with changes in the level of progesterone and estrogen, which help in the process of production of eggs.
Doctors, if necessary, to refer to surgery to remove polycystic ovary, often use the method of laparoscopy. Indications are:
- suspicion of a woman developing tumors / endometriosis or cysts,
- infertility with unknown causes
- acute adnexitis,
- syndrome of chronic pain in the abdominal cavity, not amenable to medical treatment,
- suspected apoplexy, cystoma rupture or cystic leg torsion.
Advantages of the method
Laparoscopy for polycystic ovary has many advantages compared with other methods of surgical intervention. Its advantages include:
- minimal tissue injury,
- fast postoperative rehabilitation,
- prevention of the formation of adhesions (since the internal organs are practically not subjected to compression during the operation),
- the minimum number of stitches, which reduces the risk of their divergence,
- the likelihood of inflammation and infection after laparoscopy is close to zero,
- no significant scarring.
In almost all cases of the development of PCOS, doctors record in women a reduced sensitivity to insulin, a hormone that regulates the amount of glucose in the blood.
When a large amount of this substance is circulating in the circulatory system, the ovaries begin to increase the production of androgens (male hormones). The substance violates the function and structure of the ovaries.
The hormone adversely affects ovulation, preventing the oocytes from developing normally.
Under the influence of androgens, the ovarian membrane becomes thicker, and a ripe follicle cannot break through. It does not allow the release of the egg, ready for fertilization. Unexploded follicles are filled with a liquid substance and transformed into a cyst.
So a woman develops polycystic - a cluster of several small formations. Laparoscopy for PCOS is usually carried out to cure infertility.
The advantage of the technique is the ability to eliminate the associated peritoneal factor - obstruction of the uterus tubes or existing adhesions.
During the diagnosis of PCOS, the doctor examines and interviews the patient, while he notes the outward signs of pathology and an increase in both ovaries.
Through ultrasound, the specialist selects several unexploded follicles up to 1 cm in size and prescribes diagnostic laparoscopy. During the procedure, the gynecologist takes a small piece of the ovary with a special tool.
Next, the sample is sent to histology. Endometrial biopsy is necessary for patients who have bleeding not during menstruation.
Ovarian decortication is prescribed for women with sclerocystic membrane.
The doctor removes the transformed protein surface of the organs with a scalpel or special scissors, the follicles are punctured with a needle, and their edges are sutured with special threads. This procedure helps to remove the factor that prevents ovulation.
The material that was removed from the ovaries is sent to histology. This type of laparoscopy is performed not only for medical purposes, but also for diagnostic purposes.
Notches on the ovaries
Patients with polycystic to restore the childbearing function on the ovaries make small incisions, due to which the functions of the organ are restored.
In the process of cauterization, the ovary is fixed with special clamps and, using a laser or coagulator, cuts up to 1 cm in depth are made on its shell.
At the same time, the surgeon performs incisions in places where translucent follicles are visible, thus ensuring their rupture when the egg cell matures.
The primary preparatory measure for the removal of polycystic ovarian cancer is the delivery of all necessary tests, including:
- urinalysis / blood count,
- blood biochemistry with determining the amount of bilirubin, protein, sugar,
- vaginal smear on microflora,
- blood for hepatitis, HIV, syphilis,
Laparoscopy for polycystic ovaries is performed only if all the results are normal, otherwise the risk of developing complications is high. For any health problems, the operation is transferred for treatment.
There is no specific recommendation regarding the day of laparoscopy: the procedure is carried out on any day of the cycle, except for the monthly ones itself.
When the patient is approved for surgery, she is sent to the hospital, where an additional ultrasound and ECG are performed.
In the evening, the day before the operation, you should refuse to eat after 19 hours. Laparoscopy is performed exclusively on an empty stomach, and you cannot even drink after 22 hours of the previous operation of the day.
Such measures are necessary to reduce the risk of stomach contents getting into the respiratory tract when a woman is under anesthesia. Doctors of the gynecology department are asking patients on the eve of the procedure to make an enema and shave pubis. In the morning before laparoscopy, the cleaning is repeated.
In some cases, additionally prescribed one-time evening intake of a laxative drug.
How do laparoscopy with polycystic ovaries
The operation, in contrast to laparotomic intervention, is done not by cutting the abdominal tissues, but by making three small holes with a diameter of up to 1 cm. Three manipulators to the internal organs are passed through them.
One of the tools is equipped with a flashlight and a camera, and the rest are necessary for fixing and removing cysts. During the operation, the doctor is guided by the image received on the screen.
After successful completion of laparoscopy, the doctor pulls out the tools from the peritoneal cavity and stitches or simply seals the holes on the outer surface of the abdomen.
Recovery after laparoscopy
There comes the restoration of tissues and organs after 2-6 weeks after surgery. Rehabilitation after laparoscopy with polycystic ovary involves strict adherence to medical prescriptions. These include:
- you can not have sex within 1 month after surgery (with the exception of oral),
- severe physical exertion and hard work for 4 weeks after laparoscopy are prohibited (the maximum allowable load for lifting is 3 kg),
- you can not eat salty, spicy, spicy dishes,
- banned - alcohol,
- one should undergo a rehabilitation course of physiotherapy to accelerate wound healing,
- It is recommended to take vitamin and mineral preparations such as Supradin, Vitrum, etc.
For 5-15 days, slight bloody or mucous discharge after laparoscopy may occur. The reason for contacting a gynecologist is their increased duration or profusion.
After laparoscopy, the menstrual cycle does not go astray, but remains the same. Sometimes the menstruation after surgery is slightly delayed, but, as a rule, not longer than for several days.
Do not worry if the duration or nature of the monthly changes - this is a normal reaction of the body to surgical treatment.
After surgery to remove polycystic (for 7-8 hours), non-carbonated water is allowed, after which the woman is prescribed a light restorative diet. In the next 2-3 days it is allowed to eat only liquid or puree food. Suitable products for this period will be:
- low-fat natural yogurt,
- chicken bouillon,
- shredded lean meat
- boiled rice,
- steamed fish.
Starting from 4-5 days after laparoscopy, you can eat as you used to, but it is better to exclude pickles, spicy, spicy foods and alcohol from the diet.
After surgery, the woman's body recovers over the course of 0.5–1 years and again acquires the ability to conceive a child.
In this case, ovulation can begin as early as 2 weeks after laparoscopy (this can be determined by measuring the basal temperature).
The cost of surgery depends on the stage of polycystosis, the presence / absence of complications or comorbidities and the choice of medical institution.
An inexpensive operation cannot be named - the price of the procedure starts from 7 thousand rubles.
How much does laparoscopy during pregnancy? The cost of removal of polycystic in this case is much higher, while the lower limit is 10-12 thousand rubles.
I underwent laparoscopy in a private gynecology to cure infertility. On the second day after the procedure I was able to return home. It turned out to get pregnant only after 3 years, so the operation is unlikely to help - they are given a year guarantee. A friend underwent the same procedure and became pregnant for the third month.
My reasons for laparoscopy were not passing unpleasant sensations in the lower abdomen. The doctor said that this is not a good symptom and you need to have surgery. Everything went well - in the process of laparoscopy, torsion of the cyst legs was found. It was quickly removed, and the pain syndrome disappeared.
Laparoscopy for polycystic ovaries: preparation, conduct and period after surgery
Gynecological diseases are found in almost every second woman. Among them, polycystic ovary is quite common. This pathology does not apply to infectious diseases. Therefore, it is impossible to catch them. In addition, this disease is found only among women. In some cases, the pathology is formed in adolescence.
Sometimes the disease is congenital. Laparoscopy with polycystic ovary is considered one of the methods of treatment. Reviews about this procedure are various. After all, it refers to one of the types of surgical interventions. Therefore, some women prefer to use other methods of treatment.
Nevertheless, according to doctors, sometimes this operation is necessary.
What is polycystic ovary?
Polycystic ovary refers to hormonal pathologies. The disease can be congenital and acquired during life (more often in adulthood). In the first case, it is genetically determined, that is, formed during the embryonic period. Nevertheless, congenital polycystic is diagnosed only in adolescence.
Until this time, the pathology does not manifest itself. Acquired polycystic ovary often develops on the background of endocrine disorders. These include diabetes, obesity, adrenal or thyroid disease. Sometimes polycystic forms after brain injury, long-term use of hormonal drugs.
The mechanism of development of this pathology consists in the following changes:
- Decreased estrogen and progesterone production. Increase the level of male sex hormones - androgens.
- Thickening of the ovarian tunica. As a result, the follicles are not destroyed, and the egg does not come out. As a result of ovulation disorders, infertility develops.
- Filling the follicles with liquid and forming cysts.
Similar changes occur if the pathology is acquired. In this case, the disease is called polycystic ovary syndrome (PCOS). Its symptoms include: weight gain, hypertrichosis, infertility. Signs of congenital pathology are the underdevelopment of "female appearance" (narrow pelvis, poorly formed mammary glands), acne, oligomenorrhea.
Laparoscopy for polycystic
Laparoscopy for polycystic ovary refers to surgical methods of treatment. It is used in cases where drug therapy does not help. This method of removing cysts from the ovaries is considered the most effective. In addition, compared with open surgery, laparoscopy is less traumatic. Other benefits include:
- Reducing the risk of complications.
- Shortening of the postoperative period.
- Fast recovery.
- Minimal aesthetic defects (compared with an open operation in the abdominal cavity).
Despite the clear advantages of the method, there are still debates: is it worth doing laparoscopy for polycystic ovaries? After all, some doctors advise women to try medication therapy for the beginning. In fact, in some cases, conservative treatment helps to cope with polycystic.
In order to restore the functions of the ovaries apply therapy with female sex hormones. Also appointed drugs that block the synthesis of androgens. However, drugs are not always effective. Especially in the case of acquired disease.
Therefore, if there is no effect after a course of drug treatment, laparoscopy is recommended for polycystic ovaries. By this method is meant the removal of fluid formations from the organ cavity using special surgical equipment.
Laparoscopic incisions are minimal, so they do not leave a cosmetic defect after healing. In most cases, this method helps to get rid of such a severe symptom as female infertility.
Varieties of laparoscopy for polycystic ovary
Laparoscopy for polycystic ovaries can be performed in several ways. It depends on the goal pursued by the surgeon, as well as the technical capabilities of the medical institution.
Like all such surgical interventions, ovarian laparoscopy can be diagnostic and therapeutic. The first is carried out in cases of suspected polycystic disease, when the pathology has not yet been identified with precision.
Often, diagnostic laparoscopy goes into therapeutic manipulation. The second, in turn, is divided into several options. Among them:
- Decortization of the ovaries. This type of medical laparoscopy is to remove the upper shell of the organ. Due to decorting, the surface layer becomes thinner, giving the possibility of ripening and rupture of the follicles.
- Cauterization of cysts. A similar method of treatment is performed using laser equipment. The operation consists of making several incisions on the surface of the ovary. The result is the opening of cysts and the removal of their contents. After some time, normal organ tissue is restored.
- Ovary resection. It is characterized by the removal of the part of the organ in which the cysts are located. This method cannot be used if fluid formations are located on the entire surface of the ovary.
- Electrothermocoagulation. This option of medical laparoscopy is the performance of puncturing the body in places cystic formations. At the same time, ovarian coagulation is performed to avoid the development of bleeding.
- Electrodrilling. It consists in the influence of current on the area of cysts. The contents of the formations are deleted.
All the above options for laparoscopy are considered effective. The difference between them is that not every procedure is performed in a particular clinic. Some of the treatments are considered expensive and are carried out only in specialized medical organizations.
Preparing for surgery
Laparoscopy does not require complex preparation. However, compliance with certain rules before the operation is necessary. First of all, a few days before laparoscopy, a number of diagnostic studies are performed.
These include: UAC, blood test for HIV infection, syphilis and hepatitis. A urine test is also conducted to rule out kidney disease. In addition, important laboratory diagnostic procedures are: biochemical blood test and coagulogram.
One day before the test, an ECG is performed.
In addition to diagnostic manipulations, on the eve of ovarian laparoscopy, the intestines should be cleaned. For this purpose, laxative medications or enemas are used. Considering that the operation is performed under general anesthesia, several hours before it you cannot eat food and water. It should be borne in mind that the procedure is not performed during menstruation due to the high risk of blood loss.
Stages of laparoscopy for polycystic ovary
As with any operation, laparoscopy with polycystic ovary is performed in stages. First of all, you should know that this procedure is carried out with the help of an optical instrument, a video camera and special tools. All these items are very small. Операция включает в себя следующие этапы:
- Проведение общей анестезии (внутривенный наркоз).
- Выполнение 3 или 4 разрезов на поверхности передней брюшной стенки. Диаметр каждого из них не превышает 1 см. At the bottom of the abdomen, 2 incisions are made for the insertion of surgical instruments, in the area of the navel for the optical instrument and camera.
- Injection of carbon dioxide into the abdominal cavity in order to improve the visualization of organs.
- Ovarian secretion.
- Removal of cysts. This stage can be carried out in different ways.
- Coagulation of damaged vessels. Before leaving the abdominal cavity, the doctor must ensure that there is no bleeding.
- Removal of tools from the patient's body.
- Stitching cuts.
The technique for removing cysts depends on which version of laparoscopy was planned. On average, the operation lasts from 30 to 60 minutes.
Ovarian laparoscopy and pregnancy
Many women are interested in the question: is laparoscopy compatible with polycystic ovaries and pregnancy? Naturally, the answer is yes. Indeed, in most cases, this operation is carried out to treat infertility. Therefore, in the presence of polycystic and planning pregnancy, laparoscopy is necessary. However, after surgery you can not immediately begin to conceive.
Features of laparoscopy in pregnant women with polycystic ovary
In some cases, women can conceive a child, despite the polycystic ovary. This occurs if the disease has developed recently or fluid lesions are small in size. In cases where the pathology was detected during pregnancy, surgical treatment is contraindicated. This requires strict supervision by a gynecologist.
Planning for pregnancy after laparoscopy
How to plan pregnancy after laparoscopy of ovaries in case of polycystic? If the cause of infertility was precisely this disease, then conception becomes possible thanks to the operation performed. However, 3 months after laparoscopy, a woman should take hormones. After this time a number of studies are carried out. Then you can begin to conceive a child.
Laparoscopy for polycystic ovaries and pregnancy: reviews of doctors
In most cases, doctors recommend minimally invasive surgery, as they reduce the risk of complications and are considered less traumatic.
Often there is a desired pregnancy after laparoscopy of ovaries with polycystic. Reviews of gynecologists confirm this information.
Nevertheless, doctors argue that the first stage of treatment should be drug therapy. The operation is recommended for the ineffectiveness of conservative methods.
Laparoscopy for polycystic ovary: patient reviews
Women who underwent surgery were satisfied with the result. They argue that this intervention helped to cope with such pathologies as polycystic ovaries. After laparoscopy, the reviews of the majority of patients were positive.
Some women were able to have children, thanks to the operation. Also, patients note that menstrual periods after ovarian laparoscopy became regular.
In addition to the normalization of the cycle, women indicate a change in the nature of the discharge, reduction of pain before menstruation.
Laparoscopic treatment of polycystic ovary
Polycystic ovaries are diagnosed in almost 5% of the female population. The causes of pathology are multifaceted. According to experts, the main role in the development of the process belongs to imbalances in the synthesis of hormones in the genitals.
Polycystic ovarian disease is not just a gynecological disease, but also an endocrine problem, because the mechanism of disease development, which is still being carefully studied, involves the organs of the endocrine system with brain structures regulating them (pituitary, hypothalamus).
The development of the disease adversely affects the menstrual cycle and ovulation, therefore, polycystic ovary is considered one of the causes of female infertility.
But the presence of this pathology is not a sentence at all. She is successfully treated. Laparoscopy for polycystic ovary is one of the most effective modern methods of surgical care for patients with this diagnosis. Performing an operation using the method of laparoscopy is characterized by minimal trauma and a reduced risk of subsequent complications.
What is polycystic ovary
The essence of the pathological state of the appendages in the late opening of the follicle responsible for the maturation of the egg, ready for fertilization. As a result, it lingers in the unopened follicle.
This process gives rise to changes in the normal structure of the appendages, which include multiple follicular cystic-altered formations that are not able to continue their phased physiological development.
This condition is called polycystic ovary syndrome (PCOS). It is characterized by an increase in appendages in volumes, sometimes very significant, with the presence of multiple follicles of cystic nature, having a diameter of 5-10 mm. He is accompanied by excessive secretion of male sex hormones, a rare onset of ovulation, or the complete absence of it.
The progression of the PCOS pathological process involves not only appendages as organs of the reproductive system, but also organs of other body systems of a woman, for example, the adrenal cortex, the pancreas, the hormone producing insulin, and the pituitary and hypothalamus.
The essence of the method of laparoscopy polycystic ovarian, its benefits
The ineffectiveness and ineffectiveness of conservative treatment in diagnosed polycystic ovary syndrome causes the need to solve the problem with the help of surgery. With the help of modern methods of laparoscopy, doctors help many women to successfully cure the disease and solve the problem of infertility.
In the treatment of ovarian pathology, laparoscopy is considered one of the effective minimally invasive methods of treatment. After laparoscopy does not require long-term recovery. Using incisions in the abdominal cavity, more than 1 cm in size, surgical instruments are inserted, and an optical device is inserted through an incision in the umbilical region to track the correctness of the performed manipulations.
- Can I get pregnant with polycystic ovaries?
The advantages of the method are:
- low risk of development of complications due to minor injuries, including adhesions, postoperative hernia, internal bleeding in the abdominal cavity,
- shorter recovery period after surgery,
- minimizing the risk of seam divergence due to their small size,
- excellent aesthetic result (seams that have healed over time are almost imperceptible).
The advantages of the operation laparoscopic method performed with polycystic ovary is the possibility of parallel elimination of associated pathologies - obstruction of the fallopian tubes or existing adhesions. After laparoscopy and successful treatment with hormone therapy, many patients will part forever with the diagnosis "infertility".
Stages of preparation for surgery
Any type of surgery requires some training in order to avoid problems that may arise both during the operation and after its completion. The patient is offered:
- pass tests according to the list with detailed indicators of blood, urine, vaginal smears,
- undergo additional examinations (photofluorogram, ECG, ultrasound),
- consult an anesthesiologist,
- agree with the attending physician the date of the operation,
- on the eve of the agreed time of the operation, bring the diet in line with the doctor's recommendations and perform all the necessary hygienic procedures.
Types of operations
During the operation, laparoscopy of the ovaries with diagnosed polycystosis is guided by the principles that boil down to:
- elimination of the formed follicles that have undergone cystic changes,
- the formation of necessary and sufficient conditions for the normalization of the cycle of the timely opening of the mature follicle, which ensures the release of the egg, which will allow ovulation to occur.
The doctor chooses a specific type of surgery for polycystic appendages individually for each patient, based on the existing clinical picture, the degree of pathological changes, the duration of the disease, the absence of contraindications and other factors (age, the presence of chronic diseases).
Ovarian laparoscopy for polycystic is performed using the following techniques:
- Decortication. Its essence is to remove the upper layers of the appendages, which have a very dense structure. It is performed using a needle electrode. This allows you to further restore the normal growth of follicles and their maturation and full disclosure for the release of the egg, which was impossible because of the dense structure of the follicular cavity.
- Cauterization. The process consists in performing several (from 5 to circular (radial) incisions on the surface of the appendage, which ensures the growth of a new healthy tissue capable of producing unaltered follicles.
- Wedge resection. This technique, during which the cutting of a piece of ovarian tissue of a wedge shape with the cysts present on it, is carried out. It is used with a significant growth of ovarian tissue. Sometimes during the operation up to 2/3 of the volume of the organ is removed. This reduces the production of androgens, which leads to the normalization of hormonal levels and the onset of ovulation.
- Endothermocoagulation. It is carried out with a slight increase in the size of the appendages. A special electrode on the surface of the ovary "burns" the tissue in several places (from 10-15 sites). This allows you to further eliminate the excess production of androgens.
- Drilling. It consists in the use of a special tool that excised the affected follicles under the action of an electric current, and through the existing incisions it creates the opportunity for the formation of healthy follicles.
After laparoscopy on the ovaries, the woman gets a real chance to restore all the functions of the reproductive system.
How much is the elimination of pathology?
The price of laparoscopic surgery for polycystic ovaries varies greatly.
It is influenced both by the level of accreditation of medical institutions, many of which represent the full range of medical services, including the presentation of video of successfully performed laparoscopy, and the volume of surgical intervention, which during the operation can significantly differ from the intended level during the preliminary examination.
The price starts from the lower limit of 7-10 thousand rubles.
The quality of treatment for the pathology of polycystic ovaries is indirectly characterized by positive feedback from patients, the percentage of which is quite high. After laparoscopy, many women have the opportunity to restore the normal functioning of the reproductive system, to successfully become pregnant and carry out the child.
Larisa, 29 years old
“After 4 years of marriage, I never got pregnant, although we were not protected. On a routine examination, the gynecologist advised to be seriously examined. On ultrasound, the doctor saw many ovarian cysts that were not found during a routine examination, since the ovaries were not greatly enlarged. Diagnosed - PCOS. This prevented the onset of pregnancy.
It was treated with medication, the effect is zero. A laparoscopy method was recommended, which somewhat frightened me. But after listening to more than one opinion, she decided to have an operation. They made a decortication, recovered quickly and without complications. There was a delay with monthly, but within 3 months the cycle returned to normal. And six months later I got pregnant! Thanks to the doctors! ”
Svetlana, 32 years old
“I gave birth to my first child at the age of 25. Three years later, they began to think about the second child, they did not protect themselves, but I was not pregnant. Sometimes the lower abdomen hurt, but I wrote it off for menstruations that were out of a clear timetable.
I decided to be further examined and for good reason. On examination, it was reported that the ovaries were enlarged, but the right one was still more left.
Passed tests, the level of hormones deviated from the norm, and on ultrasound the doctor stated polycystic ovary.
And on the right they found a cyst of a decent size - 5 cm, and on the left - many small cysts. Recommended surgery using laparoscopy. The decision was difficult, but I did not regret. The cyst was removed along with a part of the right ovary, and the tassels were burned out on the left. Quickly recovered and after 8 months got pregnant! Conclusion - go to the doctors, and most importantly - on time! "
How is the operation?
Any type of laparoscopy is performed under general anesthesia. Four incisions (1-2 cm) are made in the anterior abdominal wall, through which the camera and the surgeon's instruments are inserted.
Carbon dioxide is injected into the pelvic cavity to improve the visualization of organs. The doctor performs all the necessary manipulations depending on the type of intervention. The duration of the operation - 40 minutes - 1.5 hours.
This video will cover laparoscopic ovarian cautery.
Other types of operations are similar.
Period after laparoscopy
For a favorable outcome of any operation, it is important not only the skill of the surgeon and the use of modern technology.
Half the success is a smooth postoperative period, compliance with the recommendations of the doctor and no complications.
To do this, in the hospital after laparoscopy, a complex of regimen and medical measures is used.
- After a successful operation, a woman is allowed to get up on the same day in the evening. It is recommended to walk in the ward and in the following days in hospital.
- After 6 hours, the first intake of liquid food is allowed. The next day, patients are transferred to a normal diet, only in smaller portions 5-6 times.
- In the first two days, an unpleasant sensation in the stomach, which is associated with carbon dioxide residues, may disturb. Thin patients may experience mild pain in the anterior abdominal wall, legs, shoulders and neck. Then the gas dissolves and the pain goes away.
- Since laparoscopy refers to minimally invasive interventions, pain in the area of postoperative sutures is not typical. Patients with a lower threshold of sensitivity on the first day may experience pain, which is relieved by non-narcotic analgesics.
- The use of antibiotics in the postoperative period is indicated only in the presence of inflammation in the pelvic organs and with a large amount of ovarian resection.
- Of the drugs must be prescribed anticoagulants for the prevention of thrombosis.
- Discharge patients 2-7 days after surgery. It depends on the type of laparoscopy and the features of the woman's body.
The success of laparoscopy for polycystic ovaries depends on how well the woman adheres to the recommendations after discharge from the hospital.
Within a month, it is necessary to refuse sex (with the exception of oral), exercise and physical labor. Food at this time should be dietary - without spicy, salty, fatty, spicy and alcohol. Three months can not lift weights more than three kilograms.
Within 3 months, patients are prescribed treatment to restore ovarian function. Only after that should you plan a pregnancy. The operation itself is a stimulating factor, so in many cases it helps a woman to cure infertility.
If a woman’s work is not related to physical labor, then it can be started immediately after discharge from the hospital. The sick-list is discharged for the whole period of stay in the hospital plus 7-10 days after discharge.
Where to do laparoscopy
Most modern gynecological clinics and medical centers have the necessary equipment for laparoscopy. Below are several addresses of Moscow hospitals that offer this operation.
- Center for Reproduction and Family Planning (with an international fund for the protection of mother and child). Ul.Zemlyanaya shaft, d.62 (m.Taganskaya), tel: (499) 370-02-68. The price is 69000 rubles.
- Professorial clinic "Maca-Med". Ul.Klary Zetkin, d.33, block 25 (m.Voykovskaya), tel. (495) 450-10-51, (925) 589-49-62. The price is 35000-40000 rubles.
- Clinic "Family". Khoroshevskoe highway, 80 (m. Polezhaevskaya), tel: (499) 705-39-99. Price - 40,000 rubles.
Features of ovarian laparoscopy in various pathologies
Currently, surgical interventions in gynecology, if possible, are performed by laparoscopic technique. The method, which appeared at the dawn of the 20th century, was used for a long time only for diagnostic purposes. He was distinguished by high accuracy and informational content: in fact, what could be better than a visual inspection of the pelvic cavity and its organs?
At the same time, laparoscopy is favorably characterized by a small invasiveness — only a few small (no more than 2 cm) incisions on the abdominal wall are performed for intervention.
Technical progress - the development of complex manipulators and special video sensors allowed to transform the method into a medical procedure.
Ovarian laparoscopy is one of the most frequent operations in gynecology, since every 5th woman has tumors of this organ.
Preparation for intervention
The need for surgical treatment is determined by the gynecologist during the examination and examination of the patient.
To do this, he performs a two-handed palpation of the pelvic organs: the fingers of one hand are in the vagina, while the other doctor presses on the anterior abdominal wall.
После он производит забор мазков из половых путей на определение микрофлоры и клеточного состава (цитологию). При необходимости проводят:
- кольпоскопию – изучают строение шейки матки под большим увеличением для исключения предраковых состояний и злокачественных изменений,
- Ultrasound of the pelvic organs - assess the condition of the reproductive organs, the presence of pathological structures and their size.
After the indications for laparoscopy are revealed, the gynecologist prescribes a number of laboratory tests:
- general blood and urine analysis
- biochemical analysis of venous blood,
- blood test (ELISA) for HIV and hepatitis C,
- blood test for antibodies to syphilis,
- determination of ovarian cancer tumor marker in blood - CA-125,
- coagulogram (blood clotting).
In addition, preparation for laparoscopy of the ovaries includes a study of the function of the heart (ECG) and the consultation of related experts on the indications. Examination before the intervention reveals possible contraindications for its implementation and allows to exclude ovarian cancer.
3-4 days before the proposed operation it is necessary to exclude from the diet foods that cause increased gas formation: legumes, mushrooms, sweet fruits (grapes, cherries, peaches, melons).
On the eve of the intervention, it should be limited to light liquid food, and on the day of its holding food and drink are contraindicated.
Such a measure will avoid serious complications associated with the ingestion of food from the stomach into the lungs during anesthesia.
In the evening before laparoscopy and in the morning on the day of it, a cleansing enema is performed. Abdominal hair (if any) must be removed immediately on the day of surgery. Taking a hygienic shower before the intervention significantly reduces the risk of microbial complications in the postoperative period.
Methods for performing laparoscopy of the ovaries in various pathologies
The location and size of incisions during laparoscopy of the ovaries
The peculiarity of the laparoscopy technique is that the surgeon directly makes several incisions in the abdominal wall directly with his own hands. After that, all the work goes inside the abdominal cavity through various manipulators.
They are inserted through incisions and, if necessary, changed several times during the operation.
There are endoscopic scissors, forceps, coagulators - they burn down bleeding vessels and many other types of manipulators.
It turns out that the surgeon himself does not penetrate into the abdominal cavity with his hands, and he sees everything that happens on the monitor. The image on the latter transmits the video sensor, which is also inserted through the laparoscopic holes. Preparation and initiation of intervention in any case is performed in the same type, and the course of the operation itself depends on the pathology of the ovaries about which it is performed.
There are many cysts and they can develop from any part of the organ. The thing is that the female sex glands have a high functional activity: monthly they grow follicle, break it and release the egg. In such a rhythm of work, various errors often occur as a result of which a cyst or tumor is formed.
A cyst is a cavity bounded from the tissue of the ovary by a capsule and filled with some content. Inside it may be serous fluid, blood, adipose or connective tissue.
Often it has a leg - a connective tissue flagellum, which consists of ligaments of the ovary and its mesentery (folds of the peritoneum).
In it pass the blood vessels, lymphatic vessels and nerve endings of the gland and its tumors.
Removal of ovarian cysts by laparoscopy is carried out as follows:
- the surgeon captures the ovary with a clamp and fixes it tightly,
- tissue over the cyst cauterizes coagulator,
- further scissors separates the tumor from its bed,
- keeps the edges of the wound in a diluted state - this allows you to gradually separate the cyst from the tissues of the ovary,
- the husked cyst, if possible, completely removes it from the abdominal cavity. This is possible in cases where its size is not more than 5 cm,
- the surgeon examines the neoplasm bed, if necessary, cauterizes the bleeding vessels in it,
- ovarian tissue is sutured or coagulated and match the edges of the wound without stitches,
- The pelvic cavity is rinsed with a sterile solution, after which it removes the manipulators and stitches the abdominal wall.
When treating a cyst, it is important to preserve its integrity and not to contaminate the contents of the abdominal cavity. Therefore, a needle is inserted into large cysts (more than 8 cm in diameter) before separation from the ovary, through which fluid or mucus is removed from their cavity. All remote tumors and their contents are sent for histological examination.
Laparoscopy of an ovarian cyst in reproductive age is performed economically with the maximum amount of ovarian tissue retained. This measure leaves the female reproductive function unchanged and does not violate the hormonal balance. Pregnancy after laparoscopy of the ovaries is possible in a natural way and in most cases, doctors recommend conceiving a child as soon as possible.
Torsion legs cyst
In some cases, the leg of an ovarian cyst is twisted with a nearby fallopian tube, due to which the blood circulation of all the listed structures is severely impaired. A woman is worried about a sharp pain in the abdomen, which is rapidly growing, nausea, vomiting, bloating. The condition requires immediate hospitalization - laparoscopy with the twisting of the legs of the cyst is performed on an emergency basis.
In this case, adnexectomy is performed - the ovary is removed along with the fallopian tube. The surgeon finds a torsion in the abdominal cavity, after which it coagulates the cyst stem and cuts it off with scissors along with the tube. On the remainder of the last throw a loop of thread and firmly tighten to reliably stop the bleeding.
Removed tissue is removed through the entire laparoscopic opening. If the cyst is large, it is pre-placed in a rubber container, otherwise it may burst and pour into the abdominal cavity. Since its tissues are partially or completely necrotized, this leads to a serious complication - peritonitis.
As a result of such an operation, the fertility of a woman is reduced by half, since only one active ovary with the fallopian tube remains. If she does not have children or she is planning a pregnancy, the child should be conceived as soon as possible after undergoing a course of hormone therapy.
As mentioned above, ovary maturation and rupture of follicles occur every month in the ovaries.
Hormonal imbalance or hereditary features of the structure lead to the fact that the outer membrane of the gland becomes too dense and interferes with the normal course of ovulation.
As a result, mature follicles do not break, but accumulate in the ovary and form a large number of cysts.
This pathology is called polycystic, and its main manifestation is infertility. Ovarian laparoscopy with polycystic allows you to restore ovulation and conceive a child in a natural way. The operation is carried out in the following ways:
- Cauterization - the ovary is fixed with forceps, after which a coagulator or a laser is made notches up to 1 cm deep on its capsule. The surgeon selects the points at which translucent follicles are visible - this will allow them to burst when ripe and release an egg cell. Blood loss is insignificant, is only 5-10 ml.
- Wedge resection - performed on one or both sides. The surgeon captures the ovary with forceps, after which it coagulates its tissue along the contour of the region to be removed. Then with the help of scissors cuts out part of the gland in the form of a sector and cauterizes the bleeding vessels. Edges of a wound compares and imposes on them one seam.
- Decortication - the surgeon removes part of the compacted ovarian capsule with a coagulator.
In most cases, fertility (the ability to fertilize) is restored for a short time - from several months to a year. After this period, the capsule thickens again and ovulation stops, so it is extremely important to conceive a child in the next cycles after the operation.
This name is the removal of the ovary during laparoscopy. Perform it in the following cases:
- therapy of hormone-dependent breast cancer,
- traumatic rupture of the gland,
- for any tumors of the ovary during menopause, since there is a high risk of their malignant transformation.
After performing the laparoscopic approach, the surgeon places a loop of thread on the ovary mesentery and tightens it.
Similarly, he pulls it in two more places - this is necessary for reliable ligation of the feeding gland vessels. After it cuts off the ovary with scissors and removes it in parts or as a whole.
The remaining mesentery cauterizes to reliably stop the bleeding. Blood loss when properly performed the operation does not exceed 15 ml.
As a result of laparoscopic removal of the ovaries, the production of sex hormones sharply decreases in a woman; therefore, she is prescribed estrogen-progestogen replacement therapy for life. When one ovary is removed in a patient of reproductive age, fertility decreases sharply, the absence of both leads to infertility.
From the inside, the uterine cavity is covered with a special epithelium - endometrium, which is growing and rejecting every month. It is necessary for the adoption of a fertilized egg and its further development.
Endometrium is able to germinate in other organs under favorable conditions.
Particles of his fall on the ovary during menstruation or develop into them due to errors in the laying of tissues of the girl in the prenatal period.
As a result, foci of endometrioid tissue appear on the surface of the gland, which often regenerate into cysts.
A pathologically located epithelium monthly passes through the same stages as inside the uterus, with the result that cases of the formation of an endometrioid cyst are not uncommon.
As a result, the process of ovulation is disrupted and the conception of the child becomes impossible. The final mechanism for the development of infertility with endometriosis is not fully understood until now.
Laparoscopy for endometriosis of the ovary is performed to remove endometrial foci or cysts and increase the fertility of the woman.
After accessing the abdominal cavity, the surgeon assesses the area and depth of the lesion of the pathological endometrium, determines the scope of the intervention.
It burns small foci with a coagulator or vaporises it with a laser, with significant endometriosis, it resects the ovary. Endometrial cysts are removed in the usual way described above.
The probability of conceiving a child after laparoscopy increases during the first year, and then returns to the initial level. Pregnancy should be planned after a course of hormone therapy (an average of 3 months).
Since the damage to the organs and the abdominal wall is insignificant, the woman is allowed to stand up and take liquid food 6 hours after the operation. In the first few days she may need injections of painkillers (Ketorol). Almost all patients are prescribed anticoagulants for the prevention of thrombosis: Heparin, Fraxiparin, Clexane subcutaneously.
The first week after the intervention, the woman may have bleeding from the genital tract. Severe bleeding requires urgent medical advice, as it can be a symptom of a serious complication.
Monthly after ovarian laparoscopy, most women arrive on time, the duration of the cycle and its character is preserved.
Of course, this does not apply to cases where both ovaries were removed - such patients are prescribed hormone replacement therapy.
General information about the operation
The minimally invasive method of surgical treatment is used to remove various types of neoplasms in the uterus, ovaries, abdomen.
A special feature of laparoscopy is surgery with miniature instruments that the surgeon inserts through small punctures into the abdominal cavity and the affected organ. The miniature video camera transmits the image to the monitor, the doctor and the assistants clearly see the area of operation, and in the process of laparoscopy, multiple cysts are removed. Healthy ovary and polycystic
The miniature video camera transmits the image to the monitor, the doctor and the assistants clearly see the area of operation, and in the process of laparoscopy, multiple cysts are removed.
Healthy ovary and polycystic
Pregnancy after laparoscopy of ovaries with polycystic
In the treatment of infertility on the background of polycystic ovary, a positive result is given by a combination therapy: an operation to remove multiple cysts + the intake of certain drugs. Most women who have undergone minimally invasive surgery, after a course of therapy can bear and give birth to a healthy child.
Combination therapy includes hormonal drugs before and after laparoscopy:
- At the first stage, the risk factors must be eliminated: it is important to lose extra kilograms, to normalize the blood glucose levels in diabetes mellitus. Without fulfillment of this point, it is impossible to move on: violations that trigger an increase in blood sugar levels stimulate the excessive synthesis of androgens - male hormones, which negatively affect the functioning of the female genital sphere.
- After normalization of weight, stabilization of glucose levels, the doctor prescribes hormones: it is important to reduce the level of androgens that prevent the onset of ovulation. Next, the gynecologist finds out whether there are adhesions in the fallopian tubes, whether there are problems with men's health that prevent conception.
- After elimination of negative factors, the stage of ovulation stimulation follows. Types of drugs: gonadotropic hormones (Pergonal or Humegon) and antiestrogens (Clomiphene tablets). During the treatment period, a woman measures daily basal temperature (an increase indicates the onset of ovulation). To control the release of a mature egg, gynecological ultrasound is also prescribed.
Is laparoscopy effective for polycystic ovaries? Is there any pain during surgery? How fast can you get pregnant after removing multiple cysts?
These and other issues worry women who have a gynecologist diagnosed with polycystic ovary.
Reviews of patients who have undergone minimally invasive surgery, confirm the effectiveness of surgical treatment: the cycle duration returns to normal, ovulation occurs within the prescribed time frame, pregnancy occurs within 6-12 months.
An important point - taking medications to normalize hormonal levels.
Preparation for surgery is quite simple; during laparoscopy of the ovaries, the woman does not feel pain, the minimum size of punctures reduces the risk of inflammation and suppuration of the tissues. During the recovery period, the pain syndrome is moderate, injections of analgesics quickly eliminate discomfort. If you follow the recommendations of the gynecologist and endocrinologist, adhere to the restrictions, then the rehabilitation takes place without serious discomfort.
Not all ovarian cysts require surgical excision. If, nevertheless, surgery is necessary, the modern method is often used - laparoscopy of ovarian cysts. The article contains information on preparation for surgery and rehabilitation after the intervention.
About expediency of operation at detection of a large cystoma read the link.
The opinion of doctors and women who have undergone surgery to remove multiple pathological lesions on the ovaries confirms the effectiveness of laparoscopy.
Polycystosis can be treated with hormones for a long time and not always successfully in the hope of restoring ovulation, but a combination of minimally invasive surgery with conservative therapy gives high chances of pregnancy as early as 6-12 months after surgery.
In the absence of positive dynamics from the ongoing conservative therapy, despite the presence of a wide range of modern medical products, the option of choice is surgical treatment. Laparoscopic techniques are widely used in the treatment of gynecological diseases, and this problem in most medical centers is operated with the laparoscopic method.
The meaning of the operation is the excision (or damage) of the ovarian area (up to 2/3), which leads to a decrease in the amount of tissue producing androgens, which, as stated above, cause the development of polycystic syndrome and prevent ovulation. Operational intervention gives a high percentage of positive results of normalization of the menstrual cycle - about 70–85%. But the effectiveness of infertility treatment is much lower - 15–20%.
Directly the operation itself takes from 30 to 60 minutes. The exact duration depends on the individual anatomical features of the patient and the qualifications and experience of the operating gynecologist. This type of surgery is performed only in specialized medical centers under general anesthesia (most often it is endotracheal anesthesia). Оперативный доступ осуществляется через три прокола в передней брюшной стенке (один – 10 мм, два – по 5 мм), однако могут быть и другие вариации доступа – всё зависит от наличия нужного оборудования.Excision of the site of the ovary is most often performed by electrocoagulation, which allows to avoid intraoperative bleeding from the site of excision.
On the day of the operation, you are allowed to get up, walk, drink non-carbonated water. Hospitalization is 2-3 days, temporary disability - up to 15 days. It is recommended to limit physical activity for one month. Wearing a bandage is not required.
It is very difficult to name specific figures, since this pathology is operated both by state medical centers and paid ones. Much depends on the volume of the operation, the time of hospitalization, used drugs and medical equipment, as well as food, consultations, etc. Indicative figures range from $ 150 to $ 500 and above.
Why ovarian health is so important for pregnancy
If you and your spouse have just started trying to conceive a baby and it doesn't work right away, you should not be afraid. On average, couples fertilize an egg is obtained only after a year of constant attempts. But if during the year the pregnancy did not come, the most common cause in the female body is a cyst.
The reason for the appearance of cysts on the ovaries is a hormonal failure of the female body or permanent inflammatory processes. During menstruation, a follicle is formed in the ovary, inside which eggs are created. In the middle of the cycle, this formation reaches a size of 2 cm and bursts, thereby supplying the uterus with ovules, and in the body of women the period of ovulation begins. With a hormonal failure, this “bag” does not burst, and a follicular cyst is formed from it, interfering with subsequent cell renewal processes. In this case, the process of ovulation ceases to occur and conception does not occur.
Small size education can be eliminated with the help of drugs for 2 - 3 menstrual cycles, cysts of large sizes or already in a state of neglect can be surgically removed using laparoscopy.
What is the danger of cysts on the ovaries:
- When a cyst reaches a certain size, it prevents the onset of pregnancy. Since the process of squeezing the ovaries and fallopian tubes.
- A cyst can cause infections, and when twisting or forming adhesions, immediate surgery is required.
- It can develop into a malignant tumor with complete sterility of the body.
The indications for surgical intervention are formations on the ovaries with a diameter of more than 8 cm. At the same time, no improvement is found during drug treatment.
If you still manage to get pregnant with a cyst without an operation, then most women experience natural ovarian improvements. Since during pregnancy, the hormonal structure of the body is changing, which has a positive effect on health. In 4% of pregnant women, a cyst rupture may occur and an emergency operation will be required. Therefore, in any case, you need complete control of your child's process of carrying a baby by a doctor.
According to statistics, cysts that are formed in the left ovary are benign and do not interfere with the conception process, and can also self-absorb in the first trimester.
If you already have a polycystosis diagnosis, then you cannot do without an operation. Since this disease indicates a serious hormonal failure, which led to the appearance of a large number of formations at once. Before the operation, the gynecologist will try to carry out treatment with hormonal drugs, however, in most cases, laparoscopy is eventually prescribed.
You should not be afraid of the operation, as it is carried out with minimal damage to the ovarian tissue. Except when its complete removal is required. In 90% of women after successful surgery, conception occurs in the first 3 to 6 months.
What is ovarian laparoscopy
Under laparoscopy means several operations that are aimed at removing the affected tissues of the ovaries, sometimes the entire organ is removed or partially, depending on the evidence.
Conduct such an intervention when several readings in a planned manner:
- Infertility of unknown origin
- Suspected cysts, endometriosis or the presence of tumors
- The presence of chronic pain in the pelvis, did not respond to conservative treatment.
Urgently, the patient is operated on with:
- Suspected ovarian apoplexy,
- Possible torsion cyst legs,
- To tear the tissues of the body,
- Acute adnexitis, which did not succumb to traditional treatment.
As can be seen from the list, it is often resorted to surgical intervention precisely to get rid of functional infertility. Polycystic ovary syndrome (PCOS) is one of the most common reasons for not being able to become pregnant. With this disease, ovarian cysts are surgically removed in several ways:
- Decortation - removal of the upper layer of an organ by cutting with a needle electrode.
- Cauterization - cuts are made on the organ to provoke the appearance of healthy tissue.
- Wedge resection - cutting a piece of the ovary in the form of a wedge.
- Endothermocoagulation - small holes are made with an electrode.
- Electrodrilling - removal of multiple cysts with the help of electric current.
Thus, laparoscopy for polycystic ovaries is performed in different ways based on the indications.
Contraindications to surgery
There are limitations in women who can do laparoscopy, and any of its types:
- High degree of obesity (3 - 4). This is due to the problematic nature of the necessary research,
- There are irregularities in blood clotting,
- Suffered from or a period of acute severe infections,
- Surgical interventions that were performed through an incision in an organism in less than six months,
- Myocardial infarction,
- Impaired kidney or heart function,
- Peritonitis or severe flatulence,
- Abundant number of adhesions in the abdominal cavity,
- A tumor with a diameter of more than 10 cm or malignant tumors,
However, there are exceptions, in any case, admission to surgery is provided by a doctor who takes into account all the factors of your body, including the risks.
Once, in a planned operation, you have removed polycystic ovary, and pregnancy is now possible, you should go through the postoperative period and the rehabilitation period.
- After laparascopic removal of the affected ovarian tissue, there comes a period after surgery, which lasts until the discharge from the hospital of the gynecological department. A distinctive feature is the ability to move a woman immediately after surgery. And already 6-8 hours after the end of the surgical intervention, it is allowed to take liquid food.
- On the first day, feelings of discomfort in the abdominal region, lower leg, neck or shoulder are possible. This is due to the release of gas from the body, which is used during surgery.
- Painkillers after the procedure are usually not used, as well as antibiotics, since the intervention in the body is minimal. However, all appointments are at the discretion of the doctor.
- After surgery, anticoagulant therapy is performed to reduce the risk of thrombosis. This is due to a long stay in the pose when the head is below the legs. Possible postoperative period from two to seven days.
Now let's consider what period rehabilitation takes, and accordingly, after how much time can we try to become a mother again.
Full recovery of the body occurs in 2 - 6 weeks. During this time, it is necessary to comply with all the recommendations of doctors on drugs and regimen.
There are several mandatory restrictions for all women who undergo laparoscopy:
- You can not have sexual intimacy for one month. This excludes all options of proximity, which can lead to orgasm a woman.
- You can not strenuously go in for sports, only minimal loads.
- Forbidden during the month of heavy physical labor.
- Do not lift more than 3 kg for 3 months.
- With regard to food intake, it is worth refraining from spicy, salty, spicy and drinking alcoholic beverages for 2 to 3 weeks.
To accelerate the healing of the ovaries, doctors recommend to undergo a course of physiotherapy after the end of the rehabilitation period. As well as immediately after surgery, vitamin complexes should be taken.
With regard to menstruation, it is restored quickly, and in some cases, the cycle does not even get off. If, however, deviations from the usual dates of the beginning of the month are present, then after 2 - 3 months everything will return to normal.
It should be borne in mind that the cyst has an unpleasant function - it can appear again, so it is worth undergoing additional treatment at the gynecologist with treatment with drugs (gonadotropin releasing hormone agonists).
After surgery, cases of complications are very rare, but still they should be considered:
- Damage to other organs (intestine or bladder) is possible.
- Violation of the integrity of blood vessels.
- Cardiovascular injuries.
- Severe allergy to anesthesia.
- It is also possible to enter the infection or receive it in the postoperative period, as the body will be weakened.
Starting to worry about your health after surgery is worth it if you have:
- There was a temperature above 38 degrees and lasts more than a day.
- There was an unbearable pain in the lower abdomen.
- Redness and pain in the neck.
- Blurred consciousness and weakness after anesthesia for more than 6 hours.
- There was a selection of whitish or yellowish-red color.
If at least one of the symptoms you have, you must immediately contact a specialist.
Now it remains to answer the main question - when is it possible to become pregnant.
Essence of pathology
In a woman, every month a follicle matures in the ovary, it bursts, and an egg cell that is ready for fertilization comes out of it.
When polycystic occurs in this process fails - the follicle does not break, but is transformed into a cyst.
Therefore, with this disease in women, each cycle is anovulatory, and therefore pregnancy does not occur.
In addition to infertility, polycystic can also provoke other disorders in the woman's body - the menstrual cycle is disturbed, the hair on the face and body begins to grow, the general state of health worsens, obesity appears and in some cases diabetes develops.
Read about other symptoms of polycystic here.
To do this, there is drug therapy (mainly hormonal) or surgical intervention.
The process of treating a pathology is quite complex and lengthy, and often doctors can only create favorable conditions for conception, but after some time polycystic disorders return.
What is laparoscopy?
Laparoscopy is a method of surgical treatment, which is used to eliminate many pathologies, including polycystic. This is a minimally invasive intervention, which is an organ-sparing surgery.
The recovery period after it is short, and complications occur in very rare cases. Therefore, laparoscopy can be considered safe.
The essence of the procedure is as follows.
The doctor makes several punctures in the abdominal cavity, inserts a camera with a flashlight and the necessary tools into them..
Watching the process on the computer monitor, all the necessary manipulations are performed, after which all the tools and the camera are removed, the cuts are stitched. The scars after laparoscopy remain very slight, and they are easy to hide under the clothes.
In addition, this intervention requires indications that can only be determined by a doctor.
When is intervention required?
Indications for surgery are:
- infertility that is not amenable to conservative treatment
- suspected cystic or neoplastic neoplasms,
- rupture of cysts or twisting their legs,
- chronic pain in the abdominal cavity, which cannot be controlled by medication,
- acute adnexitis.
Advantages and disadvantages
Laparoscopy for polycystic ovaries is often the only option for safely conceiving a child, this operation has several advantages.:
- restoration of reproductive function and normalization of the menstrual cycle,
- small punctures, whereas with the classical cavitary surgery, the cuts are quite impressive,
- preservation of effect up to 12 months
- minimal blood loss,
- if necessary, you can diagnose pathology in detail and immediately carry out surgical treatment,
- rapid recovery period, which is not accompanied by complications.
If we talk about the disadvantages of laparoscopy, he is probably one.
If the patient does not become pregnant within a year, the reproductive function is lost..
What is a resection of the ovary?
Ovarian resection is an intervention in which only damaged tissue is removed in the organ, and healthy tissue is not affected..
This intervention does not consist in the complete removal of the gonads, so the ability to conceive is preserved. With polycystic post ovarian resection, the chances of pregnancy increase.
Resection is performed only after the woman undergoes a comprehensive examination, it is necessary to minimize possible complications.
Diagnosis before surgery
The need for surgical intervention is determined by the doctor during the examination of the patient.
Palpation of the pelvic organs, smear sampling to determine the microflora, cytological analysis.
If necessary, the following activities are scheduled.:
If a woman has direct repentance to laparoscopy, she should undergo the following laboratory tests.:
- general and biochemical blood test,
- Analysis of urine,
- blood test for hepatitis and HIV,
- blood test for syphilis,
- tumor marker CA-125,
- blood clotting test.
It is also necessary to make an ECG, and consult on the indications of narrow specialists.
How to prepare?
4 days before the intended intervention, you should stop using foods that can trigger gas formation - mushrooms, sweet fruits, legumes.
The day before the operation, it is recommended to take only liquid food, you should neither drink nor eat directly on the day of the operation. Such restrictions will avoid the unpleasant effects of anesthesia.
12 hours before the operation, and then in the morning on the day of its holding, you need to do a cleansing enema..
Hair in the pubic area should be removed immediately before the intervention.
It is also recommended to take a shower to reduce the risk of possible complications associated with exposure to pathogenic microflora.
How is it going?
After preparation, the patient receives anesthesia..
As a rule, it is an intubation anesthesia, if there are contraindications for such anesthesia, it is possible to administer a spinal canal preparation or intravenously.
Then the surgeon makes 3 incisions of 1.5 cm each, spreads the soft tissues with a probe, and inserts the manipulator tubes.. Through them, carbon dioxide is injected into the abdominal cavity so that the organs are separated from each other and access to the ovary is free.
After that, necessary tools and a camera with illumination are inserted into the abdominal cavity. Observing the process on the computer monitor, the doctor performs all the necessary manipulations.
The instruments and tubes are then removed, and the cuts are sutured.
Laparoscopy can be done as follows.:
- notches are made on the ovary,
- part of the affected tissue is removed,
- only polycystic neoplasia is removed.
On the first day after the intervention, a woman can get up and walk around the ward.. A few hours later, the doctor will allow the ingestion of liquid food, preferably, it was jelly, broth or low-fat light soup.
Although laparoscopy is a minimally invasive procedure, it still provides for intervention in the internal organs, so pain can be observed, which are relieved by analgesics or other painkillers.
All patients after laparoscopy are prescribed anticoagulants, which will prevent the formation of blood clots..
In some cases, the doctor may prescribe antibiotic therapy - if there is a risk of inflammation.
A patient may have vaginal bleeding, if their amount is insignificant is normal, but if you have heavy bleeding, you should immediately consult a doctor.
If the rehabilitation period is not complicated by anything, then after a week the stitches are removed, and the woman can go home.
But the recovery period at this stage does not end.
The following rules should be followed for about a month.:
- give up intimacy
- regularly treat seams with disinfectants,
- not overstrain physically
- do not lift weights
- not wearing tight underwear or tight-fitting clothing,
- Do not visit the beaches, baths and saunas,
- eat right.
Pregnancy and planning
According to statistics, the menstrual cycle after laparoscopy is restored after a month and a half, pregnancy occurs within six months. But in each case, the timing may vary.
In principle, pregnancy after laparoscopy is possible as soon as the recovery period ends, but before planning conception you should always consult with your doctor..
The effects of laparoscopy
If the preparation for the procedure was carried out according to all the rules, if the doctor who performed the operation is qualified and competent, and if the woman adheres to all medical recommendations during the recovery period, complications after the intervention will not arise or will be minimal.
The most common adverse effect is an allergic reaction to used medications..
Next I must say about the possible trauma of the pelvic organs, which are located in close proximity to the ovaries.
If the doctor did not follow the rules of asepsis, the risk of infection and the occurrence of inflammation in the postoperative period is possible..
Laparoscopy and PCOS
In the treatment of polycystic ovary syndrome, there are a huge variety of methods using conservative management tactics in the form of drug therapy. These are the use of hormonal drugs such as combined oral contraceptives, especially with antiandrogenic activity, the combined prescription of estregenic and progestin drugs, and the administration of pure gestagens to prepare the endometrium for implantation - to support the luteal phase. Recently, drugs that were not previously used in gynecological practice, such as metformin and its analogues (ciofor, glucofage), have been included in therapy, since endocrinology, namely patients with type 2 diabetes, was the only area of their use. However, due to numerous studies, it turned out that they can also have a beneficial effect on gynecological patients with symptoms of insulin resistance. Homeopathy also boasts an abundance of drugs and drugs for the treatment of polycystic ovary syndrome, but there are situations in which even such an abundance of funds for conservative therapy does not bring the desired result. This is especially true of women who intend to get pregnant. Not always drugs give the desired effect and not always the woman's body responds adequately to the applied therapy.
PCOS and laparoscopy, and pregnancy
In this case, doctors have to resort to methods of surgical treatment of polycystic ovary syndrome. For many women, this is the last chance to get the desired pregnancy in a natural way. Otherwise you will have to resort to the help of assisted reproductive technologies.
And this chance is laparoscopy for PCOS. The operation is minimally invasive, so this intervention remains the method of choice for polycystic ovary syndrome to stimulate ovulation. The essence of laparoscopy technology lies in the use of optical instruments, which are inserted into the abdominal cavity through three small incisions on the anterior abdominal wall, as well as with the help of laparoscopic instruments and image display on the monitor, performing the entire amount of surgery without a large incision. The diagnosis of PCOS in laparoscopy is amenable to successful correction. With laparoscopy, PCOS and the chances of getting pregnant increase significantly.
This technology has a number of significant advantages compared with the laparotomic technique of operations - a section of the anterior abdominal wall of considerable size and open entry into the abdominal cavity.
Among them are:
- Minimizing tissue injury,
- Significant reduction in the risk of postoperative complications: the development of significant adhesions, inflammatory foci, minimal entry gate for infection,
- A significant reduction in the recovery period after surgery,
- No problems with postoperative suture, since the dimensions of the incisions are up to 2 centimeters in length,
- What is important for the fair sex is a wonderful cosmetic effect after the surgery. There are practically no traces of postoperative scars.
PCOS and laparoscopy: types of surgical interventions using this technique
The types of laparoscopic surgeries, of course, depend on the goal that the surgeon pursues in deciding to choose such access.
Pregnancy after laparoscopy of PCOS: types of interventions and their effect on the reproductive function of women
Diagnostic laparoscopy is a surgical intervention method that is used when it is impossible to make a diagnosis using conservative diagnostic techniques. Doctors perform this surgical intervention in order to make a diagnosis, determine the localization of the pathological process and develop tactics for the further management of the patient.
And here laparoscopy has a significant advantage - it is the possibility of translating a diagnostic minimally invasive operation into a therapeutic, low-traumatic surgery.
Ovarian decortication. The essence of the operation is to remove the dense capsule of the ovary, which prevents ovulation. After this manipulation, it is advisable to assign hormonal stimulation.
Wedge-shaped resection - surgery, which implies excision of the wedge-shaped section of the ovary, which is located in such a way that its base is facing the organ capsule. Pregnancy with PCOS after laparoscopy using this method occurs in 70% of cases.
Laparoscopic cautery. This manipulation is a laser incision in those areas of the ovary, where sclerocystic formations are located. In their place, a tissue is formed that is capable of follicle maturation and ovulation.
In preparation for laparoscopy, as with other types of surgery, women must undergo the full range of examinations, starting with a general blood and urine test, coagulogram and biochemical blood tests, ending with functional diagnostic methods. Such as ultrasound and electrocardiography.
Surgical removal of ovarian cysts is carried out independently of the day of the menstrual cycle. Laparoscopy is contraindicated only during monthly bleeding, due to the risk of large blood loss.
On the day before the operation, a light dinner is allowed up to 18 hours, and drinking up to 22 hours. Mandatory cleansing enema.
Laparoscopy for PCOS: reviews before and after surgery
Based on the above information, from the medical side, all the positive aspects of the laparoscopic procedure for performing surgical interventions are quite colorfully presented. And it is difficult to disagree with these facts to any doctor who at least touched on the issues of obstetrics and gynecology. This is the so-called objective point of view of representatives of the medical community.
But there is always the subjective side of the question, which does not always and not in all cases coincide with the objective. From this side at this stage there are female reviews after laparoscopy of PCOS.
Laparoscopy: reviews for PCOS
Reviews of the fair sex who have undergone this surgical intervention can be divided into several categories relating to the operation itself as well as the consequences and postoperative results.
First of all, women are attracted by the widespread availability and accessibility of these techniques. In almost every city, even a small one, there is at least one medical institution where there is a laparoscopic stand, as well as hands that are ready to help desperate patients at any moment.
Laparoscopy and PCOS: reviews overwhelm Internet pages due to the enormous cosmetic effect. Now, with the availability of laparoscopy, women no longer go for surgery with the fear associated with the aesthetic effect of postoperative, scar-deformed tissues. Reviews of laparoscopy of PCOS in 99% of cases are only positive, since no laparotomic access (incision of the anterior abdominal wall for abdominal surgery) compares with a barely noticeable trace after the introduction of laparoscopic instruments. The length of these incisions is up to 2 centimeters, and their number is three, with one of them located in the navel, which also makes it even more imperceptible to prying eyes.
PCOS: laparoscopy, first-hand reviews. The duration and difference in the recovery period can be assessed only by women who have already had any laparotomic operation in the history. Such women in 95% of cases note that rehabilitation measures are much easier and less painful after scapic surgery. In some cases, already on the second day of postoperative intervention, women do not need the use of painkillers of any nature.
Even on the first day of the postoperative period, the woman experiences a much smaller pain syndrome compared with laparotomy.
On the second or third day, the patient, in the absence of complications, can be discharged home, which also has a great psycho-emotional impact on the recovery period.
PCOS laparoscopy and pregnancy chances
After laparoscopic treatment of polycystic ovary syndrome, there are a number of specific rules, the observance of which will bring your couple closer to gaining parental happiness and increase the chances of conceiving your offspring.
After the procedure itself, it should be postponed with the onset of pregnancy for at least 1 month, or even better - 3. The body needs time to recover.
However, ovulation after laparoscopy of PCOS manure occur in the first cycle after surgery and the onset of pregnancy is quite possible.
Before planning a pregnancy, it is necessary to pass all the necessary basic tests, it is especially important to detect infections and eliminate them in order to increase the chance of conception and the safe development of pregnancy.
And, of course, the calculation of the day of ovulation and sexual intercourse on the days of its alleged onset also significantly increases the chances of the onset of the most long-awaited conception of an already beloved child.