The operation to remove the uterus using the laparoscopic method - consequences. How is the operation to remove the uterus in women performed in gynecology? No earlier than a month before surgery, it is necessary

Laparoscopic hysterectomy is a simple way to perform a complex operation. Many women prefer this method when the need for surgical intervention arises. Its main advantage is that such an operation does not leave a large scar on the abdomen, because it is performed using a puncture method using small surgical instruments.

Surgery to remove the uterus is called a hysterectomy. It is prescribed only in case of a serious threat from the disease to the health and life of a woman. With special caution, only if treatment by other means is impossible, hysterectomy is prescribed to women of childbearing age.

Types of operations

Depending on the medical reasons for removing the uterus, the most suitable one is selected. efficient look operations. All of them are performed under general anesthesia. There are three types of operations, depending on how they are performed:

• laparoscopic;
• laparotomy;
• vaginal (vaginal).

The laparoscopic method of hysterectomy is considered the most technologically advanced today. To perform it, several punctures are required in the navel area, which reduces the patient’s blood loss during surgery and makes the postoperative recovery period easier for her. Small punctures are enough to completely remove the affected organ. In addition to performing the necessary removal, the laparoscopic method examines other internal organs of the abdominal cavity, which makes it possible to identify additional lesions and concomitant diseases.

The laparotomy method has a longer history in surgery and is also very reliable, although more traumatic.

With this method, a 10-20 cm long incision is made on the patient’s abdomen, through which the uterus is removed. The postoperative period is long, painful and requires the woman to stay in the hospital for a long time under the supervision of doctors.

A vaginal hysterectomy is performed through the vagina, so it leaves no external marks. The recovery period after such an operation is minimal. But this method has its drawbacks. The main conditions for performing a vaginal hysterectomy are a small size of the uterus and sufficient size of the vagina. In addition, with such an operation there is a high risk of damage to neighboring organs, because the entire operation is performed blindly, with a very small viewing area.

Contraindications and indications for surgery

The convenience and advantages of the laparoscopic method of hysterectomy have long been appreciated by both patients and doctors. But, like any other type of treatment, such surgical intervention on the female body has its reasons and its contraindications.

Indications for removal of the uterus using the laparoscopic method are different, and all of them appear as a result of the development of serious diseases:

• multiple uterine fibroids (tumors) in combination with cervical pathologies;
• malignant lesions of the internal mucous walls of the uterus (endometrium);
• pathological changes in the endometrium (adenomyosis), which cause infertility and tumors;
• polyps;
• proliferation of endometrial cells (hyperplasia).

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These diseases can be detected by early stages and stop their further development. But conventional treatment is not always effective, and it becomes necessary to remove the affected organ. Refusal of surgery can result in very serious consequences for a woman, including not only infertility, but also other disorders in the functioning of the body, including the saddest option.

Contraindications for the laparoscopic method:

• large size of the uterus, which makes it difficult to completely remove it through punctures;
• volumetric formations in the appendages that cannot be cut inside the abdominal cavity and cannot be removed entirely using endoscopic instruments;
• prolapse of the uterus, which in this case is easier and safer to remove using the vaginal method.

Before the operation, a thorough examination of the body is performed, including examinations, tests, ultrasound, and ECG. If necessary, the patient may be prescribed medications to reduce the size of the uterus and prevent the development of anemia.

Preparation for the operation and its implementation

To ensure that the operation takes place without any surprises and with minimal risks, doctors may recommend taking a number of preparatory steps. They consist of hygiene procedures and restrictions on food intake.

So, a week before the hysterectomy, it is advisable to give up foods that can lead to any disturbances in the digestive tract. The day before surgery, it is best to eat only liquid meals. 8 hours before it you should completely stop eating. Before surgery, an enema may be prescribed to cleanse the intestines.

During the entire period of the cycle in which a hysterectomy is planned, protection during sexual intercourse should be exclusively non-hormonal, using condoms. The operation itself is performed either at the beginning of the cycle, immediately after menstruation, or during ovulation. In any case, the operation must be performed no later than 3 days before the next period begins.

To normalize the functioning of the digestive system, 5 days before surgery it is recommended to take three times a day. Activated carbon. Since removal of the uterus for any woman is not only physical stress, but also psychological, you can consume herbal sedatives, such as valerian and motherwort. You should inform your doctor about taking any medications and, if necessary, stop using them completely. This is especially true for all painkillers.

Before the operation, you must take a shower and shave the hair in the perineum and abdomen. This will reduce the risk of infection when performing a hysterectomy.

A laparoscopic operation to remove the uterus takes from 20 minutes to several hours, depending on the degree of the disease and the volume of material removed. If surgery was performed before lunch, then by evening patients are allowed to drink water and get up for a short time. As a rule, postoperative hospital stay is 4-6 days.

For many years, gynecologists have suggested removing the uterus to treat uterine fibroids. There are alternative treatment methods that can get rid of the disease and save the organ.

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Doctors widely use laparoscopy to diagnose and treat gynecological diseases. This is a minimally invasive surgical intervention that allows the gynecologist, after inserting a manipulator with a video camera into the abdominal cavity, to obtain an image of the internal organs on the monitor. It is used to determine the location and size of myomatous nodes. During the operation, the surgeon has the opportunity to collect pieces of tissue for histological examination. Laparoscopy of the cervix can identify fibroids or other pathological formations.

Diagnostic laparoscopy of the uterus is performed in the presence of acute surgical pathology of the abdominal cavity. Using this method, the cause of infertility is determined. Quite often, after diagnosing the disease, the surgeon proceeds to the main stage of the operation. He removes myomatous nodes, dissects adhesions in the pelvis and abdominal cavity. Laparoscopy of the uterus is an organ-preserving method of treating fibroids.

Indications for laparoscopy

When is uterine laparoscopy performed? In addition to diagnosing diseases, gynecologists perform laparoscopy in the presence of the following diseases of the reproductive organs:

• uterine fibroids;
• ectopic pregnancy;
• endometriosis;
• rupture of the fallopian tube;
• adhesive disease;
• diseases of the uterine appendages (sclerocystosis, cysts, ovarian apoplexy).

Laparoscopy is used for sterilization and for hyperplastic processes that cannot be treated with conservative methods. Removal of the uterus is necessary to prevent cancer. It is sometimes performed in case of complete prolapse of the uterus or its pinching.

Benefits and risks of laparoscopy

The main advantages of laparoscopy are as follows:

• low tissue trauma;
• short rehabilitation period;
• lower costs of medications compared to laparotomy;
• reducing the load on the body;
• minimum period of hospitalization;
• organ preservation;
• reducing the risk of adhesions.

Despite the apparent advantages, laparoscopy has its disadvantages. During surgery, there remains a high risk of internal bleeding, which is difficult to stop using laparoscopic access. Then surgeons are forced to complete the operation by performing a laparotomy. After removal of myomatous nodes, scars remain on the uterus, which can pose a threat to the fetus and mother during childbirth. The possibility of developing an adhesive process remains.

These problems do not occur in patients undergoing uterine artery embolization by our endovascular surgeons. Since the embolic agent is introduced into the uterine arteries by puncture of a peripheral vessel, internal bleeding cannot develop a priori. After embolization, the fibroid nodes are replaced by connective tissue, and scars on the uterus are not formed. The surgeon does not manipulate the abdominal cavity, so adhesions do not develop in it.

Laparoscopy surgery to remove the uterus

Is the uterus removed by laparoscopy? Most gynecologists perform hysteroresection using a laparotomy approach. This is a large abdominal operation, which is done through an incision in the anterior abdominal wall. The uterus can be removed by laparoscopy. IN in this case the surgeon inserts instruments into the abdominal cavity through small incisions. After removal of the uterus by laparoscopy, the body's recovery is faster.

Depending on the disease that is an indication for hysterectomy, the following types of operations are distinguished:

• subtotal hysterectomy;
• total hysterectomy;
• radical hysterectomy.

Subtotal hysterectomy is performed for uterine fibroids. After removal of the uterus using laparoscopy (the video can be watched on the Internet), the woman stops menstruation and develops infertility. If the ovaries are not removed, they continue to synthesize hormones that are necessary for the female body to function normally. After the operation, a woman does not experience menopause prematurely. Many patients stop suffering from premenstrual syndrome. On the Internet you can see how laparoscopy of the uterus is performed.

During a total hysterectomy, surgeons remove the body and cervix. This operation is performed if there is a threat of malignant tumors appearing on the uterus. It is also done in the presence of pedunculated myomatous nodes localized in the cervix. It is also indicated for uterine fibroids, when the nodes begin to be located on the cervical region, on the stalk. Removal of the uterus through laparoscopy is performed in the presence of internal endometriosis with heavy frequent bleeding that threatens the general condition of the patient.

Some gynecologists perform removal of the uterus and ovaries by laparoscopy in the presence of malignant neoplasms of the uterus and both ovaries. During the operation, the uterus, appendages and fallopian tubes are removed. The operation is indicated for menopausal women who have bilateral purulent inflammation of the ovaries with the transition of the pathological process to the internal organs. Laparoscopy of the uterus and ovaries, during which both organs are removed, is performed if the patient is diagnosed with a malignant tumor of the uterine appendages, due to the high risk of cancer metastases.

Radical hysterectomy is the removal of the upper third of the vagina, body and cervix, ovaries, fallopian tubes, as well as parts of the fiber that surrounds these organs. It is performed if there is a threat or initial signs of spread of a malignant tumor to the pelvic organs. In most cases, gynecologists perform abdominal surgery. After removal of the uterus, laparoscopy is done to see if the tumor has metastasized.

The doctors of the clinics with which we cooperate take good care of the female reproductive organ. They extremely rarely offer a woman to have her uterus removed surgically. Gynecologists do uterine artery embolization for uterine fibroids. This is a procedure after which most nodes decrease in diameter. Small myomatous formations and fibroid rudiments disappear completely and never resume growth.

In the presence of large myomatous nodes, uterine artery embolization is performed first. After the formations in the uterus become smaller, a diagnostic laparoscopy is performed and the issue of further treatment is decided collectively. Our specialists always strive to preserve the patient’s organ, which is associated with being female and affects the quality of life.

Laparoscopy of the uterine body

Myomatous nodes in most cases are localized on the body of the uterus. In the recent past, they were removed through abdominal surgery. Bleeding may have developed during surgery. After surgery, many patients developed adhesions in the pelvis, which are one of the main factors of infertility.

An alternative method for treating fibroids is laparoscopy. It is performed if the following indications exist:

• multiple or single fibroids with nodes with a diameter of 30-60 mm;
• rapid growth of formations;
• superficial location of nodes;
• the presence of symptoms of compression of internal organs;
• subserous myoma formations;
• severe forms of iron deficiency anemia caused by heavy bleeding;
• circulatory disturbance in the node due to torsion of the leg.

Laparoscopy is not performed if the following contraindications are present:

• severe pathology of the liver and kidneys;
• hemophilia or hemorrhagic diathesis;
• cardiovascular diseases and respiratory system in the stage of decompensation;
• a large number of nodes located in the thickness of the uterine wall.

In these cases, our doctors collectively decide on the possibility of performing uterine artery embolization.

Laparoscopy has many advantages compared to abdominal surgery:

• allows you to preserve reproductive function;
• minimal risk of complications;
• low morbidity;
• insignificant amount of blood loss;
• short duration of postoperative recovery.

Unlike abdominal surgery, laparoscopy is performed through small punctures, the traces of which are hardly noticeable. Even with the obvious safety of laparoscopy, complications such as damage to blood vessels or internal organs and massive internal bleeding may develop during the operation. In these cases, the surgeon is forced to complete the operation by making a laparotomy incision. Sometimes, to save the patient’s life, he has to remove the uterus. These complications are absent when performing uterine artery embolization.

After laparoscopy, the patient needs to stay in the hospital for 2-3 days. Heavy physical activity is contraindicated for her. Until the body of the uterus is completely restored, the woman is recommended to use barrier methods of contraception. A year after laparoscopy, she can plan a pregnancy. For women who have undergone uterine artery embolization, doctors recommend stopping birth control 6 months after the procedure. Most of them become pregnant within a year.

Bibliography

• Lipsky A. A.,. Gynecology // encyclopedic Dictionary Brockhaus and Efron: in 86 volumes (82 volumes and 4 additional). - St. Petersburg. 1890-1907.
• Bodyazhina, V.I. Textbook of gynecology / V.I. Bodyazhina, K.N. Zhmakin. - M.: State Publishing House of Medical Literature, 2010. - 368 p.
• Braude, I. L. Operative gynecology / I. L. Braude. - M.: State Publishing House of Medical Literature, 2008. - 728 p.

Content

Hysterectomy is a fairly common operation in women over 40 years of age. Scientifically, the operation that involves removing the uterus is called a hysterectomy.

Hysterectomy is a surgical operation, the duration of which and rehabilitation after it depend on many factors. It is difficult to answer the question of how many factors influence the duration of the procedure. Great importance has how old the patient is, as well as the characteristics of her medical history. The type of surgical method affects how long the operation takes.

Removal of the uterus is a fairly serious operation, which is carried out after a detailed examination. There are strict indications for surgery in patients over 40 years of age and for certain gynecological diseases.

• malignant tumors of the uterus or its cervix;
• uterine fibroids of large and giant sizes;
• rapidly growing fibroids;
• necrosis of the node after its torsion;
• internal endometriosis in the last stages;
• gender change;
• uterine prolapse.

Some doctors recommend removal of the uterus for most women after fifty years of age as a preventive measure for cancer of the reproductive system. The decision in favor of hysterectomy is influenced by how many nodes are diagnosed in the patient and what location they are.

Positive and negative sides

After removal of the uterus, a woman is unable to become pregnant, no matter how old she is. In addition, hysterectomy is often characterized by a difficult rehabilitation period. How many complications occurred during the procedure also affects the rehabilitation period.

However, there are also a number of advantages after the manipulation, especially in women after forty to fifty years. TO positive aspects after removal of the uterus may include:

• absence critical days, need for contraception;
• disappearance of the clinical picture of many gynecological diseases;
• prevention of cancer.

Like any surgical procedure, hysterectomy is associated with certain risks both during removal and during the recovery period.

The disadvantages of a hysterectomy include:

• psychoemotional disorders;
• scar after surgery in the lower abdomen;
• pain that lasts for some time after surgical treatment;
• early onset of menopause;
• development of cardiovascular pathologies and osteoporosis;
• obligatory sexual rest.

How long does sexual rest last? determined by the doctor based on the type, volume of the operation and the characteristics of the rehabilitation period.

Anesthesia

The choice of anesthesia method depends on how long the hysterectomy will take. The type of hysterectomy and the patient’s medical history are also essential.

The operation must be performed under anesthesia. In modern gynecology, two types of anesthesia are used.

• Intravenous. Doctors perform tracheal intubation, in which the patient does not breathe independently while the operation is underway.
• Regional. The operation is performed under spinal or epidural anesthesia.

Intravenous anesthesia is indicated for abdominal operations, during which a muscular organ is removed through a traditional incision.

Among the advantages of intravenous anesthesia are:

• the patient's immersion in deep sleep;
• no pain;
• the ability to control a woman’s condition.

Regional anesthesia is recommended for laparoscopy as well as vaginal hysterectomy. The patient is conscious and does not feel pain. Spinal anesthesia works quickly, also relaxing the abdominal muscles. During epidural anesthesia, the loss of sensation occurs later, and therefore this method is often used after surgery to relieve pain.

The choice of anesthesia method depends on the type of hysterectomy, as well as on the woman’s medical history. When choosing pain relief, doctors take into account how long the operation will take. Surgery to remove the uterus usually lasts up to three hours.

Varieties

Exist various options operations to remove the uterus, which differ in the method of execution and the duration of the intervention. Of great importance is how many organs should be amputated.

According to the volume of amputation, there is a hysterectomy.

• Subtotal. This surgical treatment involves removing only the uterine body.
• Total. During the operation, the uterus and cervix are removed. In another way, such amputation is called extirpation.
• Hysterosalpigno-oophorectomy. The operation involves removal of the uterine body, ovaries, appendages and cervical part of the uterus.
• Radical. Another name for amputation is extirpation, which includes the uterus, appendages, as well as the upper vaginal third, tissue around the uterus and lymph nodes.

Hysterectomy varies depending on the access to the organs being amputated.

• Laparotomy. Surgery is performed by making a traditional horizontal or vertical incision in the abdomen.

• Laparoscopy. It lasts about an hour and is performed through small holes in the abdomen that provide access to the laparoscope.
• Vaginal hysterectomy. The method is performed using access through the vagina.
• removal through the vagina using laparoscopy.

Radical removal is recommended for oncological tumors, while total intervention is performed for myomatous nodes and various forms of endometriosis. Often, the issue of amputation of appendages is decided by the doctor during the operation.

Abdominal surgery has a number of advantages, among which are:

• affordability;
• reliability;
• low risk of complications after removal;

The disadvantages of laparotomy include:

• scar after removal;
• the duration of inpatient treatment is about ten days;
• long-term rehabilitation.

Laparoscopy is one of the more modern surgical methods of treatment. This type of removal takes less time.

The laparoscopic method has many positive aspects:

• the duration of rehabilitation is insignificant;
• absence of scar and adhesions after surgery;
• The length of hospital stay is about five days.

The disadvantages of laparoscopy are as follows:

• relative high cost;
• risk of using abdominal surgery.

Many representatives are interested in how long it takes to recover after a vaginal hysterectomy. In general, this type of removal is a fairly gentle procedure. In addition, after the operation there are no abdominal scars or pain, and rehabilitation is about four weeks. However, no matter how many advantages this technique has, it is necessary to note its complexity and high risk of complications after manipulation.

Contraindications

In some cases, hysterectomy is contraindicated.

Contraindications to this type of surgical intervention include:

• exacerbation of any chronic diseases;
• inflammatory processes in the reproductive sphere;
• severe pathologies not related to the field of gynecology;
• pregnancy period.

• large volume of the uterus;
• extensive adhesive process.

Vaginal uterine removal is not performed if:

• adhesions;
• presence of a scar after cesarean section;
• large fibroids;
• inflammatory processes and cancer alertness.

The duration of the operation depends on its type. The clinical picture of the pathology that necessitated surgical treatment is essential.

Preparatory stage

Hysterectomy is a common, but at the same time complex surgical tactic. Before it is carried out, careful preparation is necessary, during which the patient undergoes the necessary examination.

Women are interested in what procedures need to be performed before amputation. As a rule, preparation for surgery includes performing:

• urine and blood tests;
• vaginal smears for flora, bacterial culture, STIs, oncocytology;
• colposcopy;
• Ultrasound of the pelvic organs;
• fluorography.

Before hospitalization, a woman also needs to consult a therapist, phlebologist and dentist.

Often, before the manipulation, hormonal treatment is prescribed, which helps stabilize pathological condition. The woman is hospitalized in the hospital at least one day before the operation. Before the operation, a diet and a cleansing enema are indicated. On the operating day, eating and drinking any liquid is prohibited.

How long the operation lasts depends on many factors. In general, the duration of the manipulation depends on the type of removal and the clinical picture of the pathology. It is also important how the removal process itself proceeds, since various complications cannot be excluded during and after the operation.

In gynecological practice, surgery to remove the uterus lasts from forty minutes to two to three hours. If unforeseen situations arise, the duration of the intervention increases.

Many women, faced with the problem of hysterectomy, fall into real despair and panic. But don't despair. In some cases, only surgical removal of the uterus remains the only sure way to cure a complex gynecological disease - most often we are talking about endometriosis, various pathologies accompanied by heavy bleeding, as well as malignant or benign neoplasms in the reproductive organs. According to medical statistics, more than 30% of women over the age of 45 are faced with the need surgical removal this most important female reproductive organ. Modern medicine offers several methods of surgical removal of the uterus, one of which is laparoscopy. Today, laparoscopy is considered the optimal, most effective, gentle and safe surgical method.

What is laparoscopy?

Laparoscopic hysterectomy is what medical circles call removal of the uterus through laparoscopy. Laparoscopic amputation of the uterus is considered the optimal solution if there is a need for such surgery. This technique has many advantages, the most important of which are:

Minimal trauma. Minor pain syndrome, almost complete absence of adhesions. Absence of rough scars and scars on the surface of the abdomen. In some cases, removal of the uterus by laparoscopy allows you to save other reproductive organs - for example, the cervix. And this always has a positive effect on the condition women's health. One of the undoubted advantages of laparoscopy is the 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 removal of the uterus, a woman is allowed to get out of bed and walk, and after 3-4 days she can be discharged from the hospital. Approximately 2 weeks after the operation, the woman can return to an active, full life. This is very important for working ladies. The level of postoperative complications is minimal. When performing surgery, the surgeon carefully controls his every movement, so damage to other internal organs, blood vessels, as well as internal bleeding, both during and after the operation, are extremely rare. Already 4-6 weeks after the operation to remove the uterus, a woman can return to sexual activity. After laparoscopy, no visible scars or scars remain on the surface of the abdomen.

Indications for laparoscopy

This method of uterine amputation is used in the following cases:

It is laparoscopic removal of the reproductive organ that is recommended in the case of cancer of the reproductive organs. Malignant neoplasms of the ovaries and cervix are considered the main indication for removal of the reproductive organ - this helps stop the disease and prevent the spread of cancer cells to other internal organs. Rapidly progressing uterine fibroids, which manifests itself in many small nodes, or in several large neoplasms. Heavy uterine bleeding, the nature of which has not been identified.

Pathological prolapse and prolapse of the uterus is considered a serious indication for laparoscopy.

How is laparoscopic hysterectomy performed?

Removal of the uterus by laparoscopy begins with preparing the woman for surgery. To do this, you should stop taking any medications 7-10 days before surgery. Ladies who smoke are advised to give up the bad habit a week before amputation. In addition, it should be remembered that for every representative of the fair sex, the removal of the most important reproductive organ is a serious psychological trauma. Therefore, in many cases, before laparoscopic removal of the uterus, consultation with a psychologist will not be superfluous.

Laparoscopy is considered one of the modern minimally invasive surgical methods. The operation is performed under general anesthesia. The surgeon makes several small incisions on the patient’s abdominal wall - about 3-4, no more than 2 cm in size. Next, a special video camera, a lighting device and all the 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 giving the surgeon the necessary overview.

After inserting laparoscopic instruments, the doctor crosses the uterus, ties 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 vaginal area 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 - in approximately 1 woman out of 100 who have undergone this surgical intervention. Among possible complications can be distinguished:

Despite the fact that during the operation the surgeon sees the whole picture through a special monitor and controls every movement with surgical instruments, in rare cases accidental injury to other internal organs cannot be ruled out. Damage to blood vessels during abdominal puncture or direct amputation of reproductive organs. Certain harm female body may apply carbon dioxide, which is injected into the abdominal cavity for better visualization. The occurrence of adhesions in the pelvic area. In extremely rare cases, not exceeding 1% of all operations, the patient develops infectious complications.

Postoperative period

After the uterus has been removed using the laparoscopic method, the patient remains in the hospital under the constant supervision of doctors for at least 6-8 days. The duration of the recovery period directly depends on the woman’s age, her well-being, the extent of the amputation and the presence of any complications. The recovery period begins immediately after the operation - on the first day after removal of the uterus, the woman feels pain in the lower abdomen. This is an absolutely natural phenomenon after amputation of internal organs. To remove pain syndrome The patient is prescribed analgesics and painkillers medications. In case of severe pain, narcotic painkillers may be prescribed.

Experts advise women to get out of bed and walk a little within a few hours after laparoscopy. Why is it welcome? physical activity? This stimulates blood circulation and is an excellent prevention of thrombophlebitis. Of course, all movements must be measured and careful.

During the postoperative period, you should wear a special compression bandage and stockings. This is necessary in order to restore the full functioning of internal organs and prevent the development of thrombophlebitis. Removing the compression bandage is strictly prohibited - this can only be done with the permission of the doctor who performed the operation. You will have to wear a compression bandage and stockings for at least 14 days.

The postoperative period requires strict antiseptics of the operated area. To do this, the seams should be treated with antiseptic solutions daily. In a hospital setting, this is done by medical personnel, who also change sterile dressings. After discharge from the clinic, the woman must independently treat the stitches with antiseptics.

During the recovery period, it is not recommended to take baths or take a hot shower. Only partial hygiene procedures are allowed. You should also remember some other restrictions that must be observed during the rehabilitation period:

Sports or any other type of physical activity is strictly prohibited. The rehabilitation period requires complete abstinence from sexual intercourse. Return to sexual life is possible only 4-6 weeks after laparoscopic hysterectomy. During the rehabilitation period, a woman is not allowed to lift weights that weigh more than 3 kg. Visits to saunas, baths, public reservoirs or swimming pools are not allowed.

Minor bleeding from the vagina that appeared after surgical removal of the reproductive organs is the norm and should not be scary. Use regular hygiene products that are used during menstruation. As a rule, 2-3 weeks after laparoscopy, the discharge stops on its own.

The recovery period after amputation of reproductive organs requires careful adherence to diet. On the first day after surgery, you are allowed to drink a small amount of liquid – non-carbonated mineral water, weak tea, fruit juice, berry or fruit compote, low-fat broth. On the second day after removal of the uterus, you can include food in your diet, preferably in pureed form. In the future, you can add familiar dishes to the menu - but you should strictly limit the use of spicy, fried and fatty foods. Strong tea and coffee, cocoa, alcoholic drinks, spicy pickled or canned foods, confectionery, fatty meats and fish.

Abroad, removal of the uterus (Hysterectomy) is an operation that, after 40 years, is prescribed to many women in order to avoid possible appearance tumors or fibroid growths. This procedure is not uncommon; although many women are scared possible consequences, but often this the only way cope with the disease.

Hysterectomy is now one of the most common gynecological operations. After removal of the uterus, a woman loses the ability to become pregnant and bear a child. However, very often there is simply no other way out, since the patient’s life is at risk.

Indications for removal

In what cases is the uterus removed:

The main reasons for hysterectomy are cancer of the ovaries, uterus, or cervix. Often the uterus is removed when fibrosis or fibroids (benign tumor) of the uterus are diagnosed, and less often - with endometriosis. In rare cases, the uterus is removed after childbirth: in case of heavy uterine bleeding caused by injury or postpartum infection.

Preparing for surgery

Hysterectomy is a rather serious matter and the procedure is performed in an inpatient setting.

Hysterectomy is the most common gynecological operation.

Before the operation, doctors conduct a thorough examination and confirm the diagnosis using ultrasound and X-ray methods. A biopsy may also be taken. The patient must undergo a consultation with an anesthesiologist to identify and prevent possible allergic reactions to drugs. The day before removal of the uterus, a special slag-free diet and bowel cleansing with an enema are prescribed. On the day of the procedure, the patient is given sedative to reduce fear of surgery.

Removal of the uterus, ovaries and appendages

Hysterosalpingo-oophorectomy is an operation in which the uterus is removed along with the appendages and ovaries.

This procedure is the only hope for recovery for many women; in addition, heavy bleeding and severe pain stop, and the constant feeling of discomfort disappears.

Abdominal surgery

If there are no contraindications, then general anesthesia is performed for this operation. In modern German clinics, the operation lasts about 30 minutes. At the site of the incision, a seam approximately 20 cm long remains, it can be horizontal or vertical. It is necessary to wear a post-operative bandage after removal of the uterus for better tissue healing.

Laparoscopic uterus removal

A gentle method of removing the uterus is laparoscopic hysterectomy. This method avoids large abdominal incisions. Laparoscopic removal of the uterus is performed using special equipment:

Small incisions are made in the abdomen through which tubes are inserted; A video camera and the necessary surgical instruments are inserted into the abdominal cavity through tubes; To provide the surgeon with an overview and access to the uterus, the abdominal wall is raised above the organs using gas injected through a special tube - a cannula.

The consequences after removal of the uterus using the laparoscopic method are minimal and postoperative recovery of the body is faster than after abdominal surgery.

“Surgery to remove the uterus” - Video

The video talks about modern gentle methods of performing hysterectomy surgery.

Operation price

How much does a hysterectomy cost? Treatment in Israel is the cheapest.

Practice shows that the level of Israeli medicine is quite comparable to the world, and prices are 30-40% lower.

In general, the cost of a hysterectomy operation in each case is calculated separately and greatly depends on the country, city, level of the clinic and the characteristics of your body. Of course, simple removal of the uterus will cost much less than extirpation - complete removal of the uterus along with the appendages and ovaries.

After operation

Postoperative period

During abdominal surgery, the patient spends about 2 weeks in the hospital. 7 days after the procedure, the doctor removes the staples from the suture. The speed of healing depends on the physiological characteristics of each patient.

If the hysterectomy was global, that is, all ligaments and lymph nodes were removed, then significant changes occur in the pelvic area, which prolong the recovery period after removal of the uterus.

Recovery and rehabilitation

Postoperative therapy is aimed at restoring water and electrolyte balance and blood, as well as preventing inflammatory processes.

It is imperative to pay attention to the psychological aspect: any operation is stressful, and gynecological surgery is a very serious shock for any woman.

Sick leave after hysterectomy is usually issued for a period of 25 to 45 days. Some women tolerate the operation very easily and return to work after 3 weeks.

Diet

In nutrition after removal of the uterus, a woman must adhere to a gentle diet: no aggressive or irritating foods. The following should be excluded from the diet: confectionery, coffee and strong tea, cottage cheese, chocolate, white bread.

To “start” the functioning of the intestines after surgery, you need to eat little by little, but often - 5-7 times a day. Daily water consumption should be increased to 2-4 liters. It is necessary to consume foods that have a weakening effect:

porridge, meat broth, fermented milk group of products.

The basic rule is to strictly adhere to the diet prescribed by the attending physician, both in the first days after completion of the operation and after discharge.

Physical exercise

During the rehabilitation period after removal of the uterus, the loads should be feasible; you should not lift more than 5 kg.

Of course, carry out any physical exercise It is necessary only after the incisions have completely healed, otherwise the stitches may come apart due to excessive efforts. It would be wise to consult with your doctor; he will tell you which gymnastics after 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. So moderate exercise stress will prevent blood from stagnating in the organs, and the healing process will go faster.

Possible complications

Pain after removal of the uterus may be due to the formation of adhesions or bleeding. These symptoms often appear during the first time after surgery. Also, the consequences of the operation can be thrombosis of the deep veins of the legs, various urination disorders, suppuration of the suture, and hematomas. All these complications significantly prolong the recovery process. Often, after removal of the uterus, women experience all the symptoms of menopause. It is also possible to experience a decrease in libido and vaginal dryness, but such complications are the exception rather than the rule. After removal of the uterus, patients become more susceptible to diseases such as osteoporosis and atherosclerosis.

Discharge after hysterectomy

After removal of the uterus, spotting is possible, since the functions of the ovaries are not affected, and sex hormones affect the cervix. In this case, the main thing is that there is no increase in discharge.

If you have any concerns, you shouldn’t wait for everything to go away on its own. Be sure to consult a doctor for an examination and a correct diagnosis.

If you have any concerns, contact your doctor immediately.

In the following cases, it is necessary to notify the attending physician:

The discharge causes an unpleasant odor, nausea, and fluid incontinence; The presence of large clots in the discharge; The need to change pads multiple times within an hour and the presence of bright red blood discharge from the vagina.

HRT

HRT - hormone replacement therapy - is necessary after removal of the uterus and ovaries, because the body loses the ability to produce hormones on its own without the ovaries. So hormone therapy after hysterectomy is recommended for all women, regardless of age. In fact, this is a replacement for ovarian function lost as a result of surgery.

HRT uses:

gestagens, estrogens, sometimes androgens.

For use hormonal drugs After removal of the uterus, there are a number of contraindications, which are clarified during a comprehensive gynecological examination.

Reviews

The services of Israeli and German doctors enjoy the best reputation.

In general, the operation for most women is successful and without complications. In addition, foreign clinics carry out postoperative monitoring of their patients. This way the doctor will be able to notice in time if something goes wrong.

To identify diseases in the early stages and diagnose predisposition to them, it is advisable to regularly undergo a comprehensive examination of the body.
In our article at the link you will find out what is included in the examination, where it is best to take it and how much it costs.

You can find more information on this topic in the Gynecology section.

Uterine fibroids are considered the most common benign tumor of the female genital area.

There are many ways to treat this disease, but surgical methods are considered the most effective. One of the popular tactics for myomatous treatment is laparoscopic surgery.

Concept

Even in the recent past, myomatous tumors were removed only through open surgery, which caused many complications such as internal bleeding, adhesions and loss of reproduction.

Today, the laparoscopic technique is considered the best alternative therapeutic solution to open abdominal surgery. Moreover, after laparoscopy, which helps to successfully remove myomatous formations, no traces remain.

The procedure is carried out using special instruments that reach the fibroids through small abdominal punctures. A special video camera is used to visualize what is happening during 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 education prevents conception or pregnancy; With a superficial location of fibroid formations; If the nodes put strong pressure on the urinary system and intestines; Subserous myoma formations; The presence of severe forms of iron deficiency anemia caused by heavy bleeding; Impaired blood circulation in the node due to torsion of the leg or other reasons.

Not every patient is allowed to undergo laparoscopic removal of fibroid tumors.

Thus, it is prohibited to remove fibroids in this way for women who have:

Problems with the digestive system, liver pathologies; Hemophilia or hemorrhagic diathesis; Cardiovascular or respiratory pathologies; Suspicion of malignancy of the node; Too many nodes located in the thickness of the uterine wall.

In addition, laparoscopic removal of fibroid nodes is contraindicated in the presence of a hernial process in the peritoneum, insufficient or overweight, ovarian or cervical oncology, large size nodes (more than 12 weeks).

Advantages

Laparoscopic surgery has many advantages compared to other surgical interventions, one of which is minimal trauma and the absence of postoperative marks on the body, which is important for a woman.

Experts note the following advantages of the laparoscopic technique:

This technique is indispensable for surgical intervention in nulliparous patients, since it is organ-preserving and preserves the ability to bear children; Laparoscopic removal of fibroid nodes has a minimal risk of complications during and after the operation; The operation is characterized by low trauma, no risk of bleeding and the development of adhesions; Minimal likelihood of myomatous relapse in the future; Short postoperative recovery period, about 3-4 days; There is no need to take painkillers in the postoperative period, because patients are not bothered by pain.

Unlike abdominal surgery, which requires a large incision in the peritoneum, laparoscopy is performed through small punctures, the traces of which soon become completely invisible.

Types of laparoscopic surgery to remove uterine fibroids

Laparoscopic surgery can be conservative or radical.

With conservative laparoscopy, nodes are removed, i.e., myomectomy is performed. If the patient is indicated for radical laparoscopy, then during such an operation the uterine body is completely removed, i.e., a hysterectomy is performed.

Removal of the uterus while preserving the ovaries ensures a complete loss of menstrual function, however, the appendages continue to function and fully produce hormones. That is why the menopause comes on time and the patient does not have any adverse reactions that are traditionally observed when the ovaries are removed.

Preparation and course of therapy

Preparatory measures for laparoscopic removal of uterine fibroids include laboratory tests and instrumental diagnostics.

Such studies make it possible to identify the presence of specific contraindications and determine the location and nature of the formation.

Laparoscopic surgery begins with pain relief. It is performed using epidural anesthesia or general anesthesia. Then punctures are made in the peritoneum necessary for introducing instruments. Carbon dioxide gas is released into the retroperitoneal cavity, which expands the abdominal walls, which provides more space for surgical manipulations. A laparoscope is inserted into the puncture, which visualizes the uterine body and other organs, and also helps to determine the locations of other punctures (there are 4 of them in total). Z Then the nodes are deleted, and if necessary, then the entire uterus.

The laparoscopic operation lasts no more than 2 hours, and within a few hours after the intervention the patient is allowed to walk.

Complications

Even with such a safe removal of fibroids as laparoscopy, there is a possibility of postoperative complications.

In general, all complications are divided into 2 classes:

Occurring during any laparoscopic interventions or general; Characteristic only for fibroid formations or specific.

Common complications include vascular injuries or intraorganic damage caused by the insertion of devices. In addition, complications may be caused by anesthesia, respiratory disorders, hematomas of the uterine walls, defects due to improper suturing, or infectious complications.

As for specific complications, they may include uterine or fibroid bleeding, hernial processes in the peritoneum, etc. In addition, for the first couple of days the patient will be bothered by nagging painful sensations in the lower zone of the abdominal wall.

If the fibroid nodes are located low or are interstitial in nature, then during laparoscopy the intestinal, bladder structures or ureters may be damaged.

Postoperative period

After laparoscopic surgery for uterine fibroids, the patient is prohibited from any heavy physical activity, however, walking or just walking is simply necessary for a woman at this time to prevent adhesions.

If you are concerned about pain, which is relatively rare, then taking painkillers is recommended. Some ladies are advised to wear anti-varicose stockings, especially those who already have varicose veins.

In the first days of postoperative rehabilitation, experts recommend staying in a hospital, although already on the third day the patient is allowed to go home.

Simply, in a hospital setting under medical supervision, the body will recover, and the blood composition will also normalize. If necessary, the woman is provided with symptomatic therapy, and antibiotic therapy is prescribed to avoid inflammatory complications.

A woman needs to clarify the date of her expected menstruation and the contraceptives that can be used in her case. Protection in this situation is necessary to prevent pregnancy until the full restoration of the uterine body occurs.

Depending on the pathology picture and the operation performed, conception is allowed after a year after laparoscopic removal of fibroids. By this time menstrual cycle should be completely normalized.

Diet after laparoscopy

Laparoscopic removal of uterine fibroids does not provide for strict restrictions on the diet in the postoperative period, however, you still need to adhere to some restrictions.

Food should ensure the smooth functioning of the intestinal structures so that there is no constipation, which can cause tension in the peritoneum and divergence of the uterine sutures.

In addition to intestinal functionality, the principles proper nutrition allow you to bring body weight to normal levels, and also help cleanse the body of toxins.

In other words, a balanced diet allows you to eliminate several factors that provoke the occurrence of myomatous processes.

Price

Price parameters for laparoscopic removal of uterine fibroids vary significantly depending on the status of the medical center, its geography, the qualifications of the surgeon and other factors.

On average, laparoscopic surgery will cost 17,000-90,000 rubles. If we talk about foreign clinics, the price of such an operation in the USA is 6,000 euros, in Germany and Israel it is approximately 7,500 euros.

Last updated April 20th, 2019 at 08:58 pm

Among gynecological diseases, there are particularly complex pathologies that cannot be cured without surgical methods. The most serious operation is hysterectomy - removal of the uterus when diagnosing disorders that threaten a woman’s life. The laparoscopic method is recognized as the most minimally traumatic option for surgical intervention in modern medicine, allowing to protect the patient from dangerous complications after traditional abdominal surgery.

Laparoscopic surgery, which medicine became familiar with more than 20 years ago, is successfully used in gynecology. In the past, laparoscopy was used for minor gynecological surgeries. Today, in the field of gynecology, many clinics use the laparoscopic method due to its low invasiveness. Removal of the female reproductive organ (uterus) is carried out through small incisions in the abdominal cavity without the threat of large blood loss.

Important video about how to avoid hysterectomy.

The sad consequence of hysterectomy is the inability to conceive and bear a fetus. An important advantage of resection is the elimination of the threat to a woman when diagnosed with fibroids or endometriosis with the prescription of hormone replacement therapy.

When can amputation be prescribed?

In a woman's body, the uterus provides the function of procreation. Externally, the organ looks like a small sac with elastic walls, which is necessary for bearing a growing fetus. The following pathological deviations may be prerequisites for choosing the laparoscopic method:

• proliferation of muscle tissue of a benign or malignant nature;
• problems with conceiving or bearing a fetus due to endometriosis;
• pathologies associated with prolapse or prolapse of the uterine body;
• the presence of multiple nodular formations of small or large size;
• violation of the integrity of the uterus during pregnancy, as well as labor;
• development of acute inflammation of nearby organs.

If the gynecologist has prescribed laparoscopic removal of a tumor on the uterus, do not be alarmed. The ability to broadcast the progress of the operation on the monitor facilitates the safe disposal of even large tumors. Preserving an organ thanks to laparoscopy does not deprive a woman of the happiness of motherhood.

Types of surgical methods

Regardless of the type of uterine tumor, the laparoscopic method is the most minimally invasive type of surgery, which allows you to fully preserve the function of the reproductive organ.
Resection of an organ important for a woman is prescribed when conservative forms of treatment are powerless, as well as in the event of an alleged threat to the patient’s life. Based on the type of access to the object and the method of implementing surgical measures, a certain type of surgery is chosen to remove the uterus.

1. Using the laparoscopic method, organ-saving surgery is performed with the possibility of visual control of the surgeon’s actions. The surgeon gains access to the organ through small incisions in the peritoneum.
2. Laparotomy surgery is considered more reliable, but patients find it difficult to tolerate the peculiarities of the postoperative period. Resection involves making a large incision in the abdominal cavity.
3. Due to the lack of visibility, the extirpation technique is often supplemented with laparoscopic intervention. Hysterectomy is performed using vaginal access in case of a global pathological process.

Diagnostic laparoscopy.

Due to the versatility of laparoscopy, it can be used not only for resection of the reproductive organ, but also for diagnostics. Using special manipulators, the doctor gains access to internal organs to assess their condition.

Laparoscopic removal method

Surgical intervention is the most in a modern way carried out under anesthesia (local or general) in a hospital setting. The manipulation is preceded by a special training program for the patient.

Removal of fibroids in the uterus using the laparoscopic method.

Stages of preparation and performance of surgery using the laparoscopic method

1. During the preparatory period (2 weeks), the patient undergoes an examination to obtain the results of laboratory tests and examination by specialists. A few days before the intervention, foods that disrupt digestion are excluded from the diet. On the day of the hysterectomy, a cleansing enema is indicated.
2. After anesthesia, the surgeon makes 3-4 small punctures on the surface of the patient’s abdomen. Through one of them, the abdominal cavity is filled with harmless gas to expand the peritoneal space. The remaining incisions are used to insert instruments - lighting devices, manipulators, a laparoscope with a miniature video camera.
3. The doctor watches the necessary surgical procedures on the monitor screen. The possibility of visual control provides a detailed overview of the condition of the uterine pharynx and determines the degree of tissue damage. The process of removing the uterus or a tumor on it takes place without damaging neighboring organs.
4. During the operation, the surgeon easily removes small fibromatous nodes using the laparoscopic method. Large units are first crushed and then evacuated using a special device. In case of removal of a large uterus, it is cut into several parts for safe removal from the peritoneum.
5. After forced amputation, the surgeon must ensure that the vessels are ligated securely and that there is no bleeding. Abdomen free from instruments, blood residues, and expanding gas. After examining the walls of the peritoneum, the doctor applies an anti-adhesion mesh to prevent the appearance of a postoperative scar.
6. At the final stage of the intervention, using the laparoscopic method, the edges of the abdominal incisions are connected with intradermal sutures. The application of cosmetic sutures, which dissolve after 3 months, does not result in aesthetic problems for the patient.

Based on the volume of surgical procedures performed, the duration of the operation is 20 minutes or about an hour. In case of complications, the procedure can last several hours. Upon discharge from the hospital, the patient receives a disc with a record of the progress of laparoscopy.

Chronology of the postoperative period

Rehabilitation after resection of the organ necessary for conception does not require a long time; the duration of the stage is on average one month. The duration of the recovery period is influenced by the patient’s age, the degree of impact on the uterus using the laparoscopic method, and the development of postoperative complications. How is the rehabilitation going:

• the first hours - recovery from anesthesia, taking painkillers, antibacterial drugs that reduce the risk of inflammation;
• the first day after removal of the uterus - to stimulate blood circulation, it is recommended to begin gentle physical activity;
• While walking you should wear special stockings, use a bandage, and to clean your lungs you should start inflating balloons;
• in a hospital setting, antiseptic treatment of postoperative wounds is carried out daily;
• seventh day - discharge from the medical institution with a 2-month restriction on heavy physical labor and sexual activity.

After surgery using the laparoscopic method, strict antiseptic treatment of the operated abdominal area is important. The patient will have to apply sterile dressings at home independently.

• Limit hygiene procedures by avoiding hot showers and baths. Washing is only allowed partially so as not to wet the seams. When can I return to intimate life, your personal gynecologist will tell you.
• Do not be alarmed by the appearance of light bleeding from the vagina. The unpleasant consequences of laparoscopic hysterectomy stop spontaneously after a maximum of 3 weeks.
• Monitor your diet from the first days after surgery. After being discharged from the hospital, you can return to eating your usual foods, excluding fried, spicy, fatty foods, and alcohol.

The only disadvantage of the laparoscopic method is the high cost. surgical manipulation- up to 120 thousand rubles. But the guaranteed possibility of conceiving a child with partial hysterectomy and the high aesthetic effect after laparoscopy will be strong arguments in favor of choosing a modern surgical technique.

Treatment of uterine fibroids without surgery. FUS-MRI method.

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