The use of laparoscopic methods when removing the uterus. Removal of the uterus using the laparoscopic method: rationality of using the technique Removal of the uterus and ovaries using the laparoscopic method
![The use of laparoscopic methods when removing the uterus. Removal of the uterus using the laparoscopic method: rationality of using the technique Removal of the uterus and ovaries using the laparoscopic method](https://i0.wp.com/vashamatka.ru/wp-content/uploads/2017/11/laparoskopiya_matochnih_trub_1094_718.jpg)
About 30% of the female population over the age of 40 is faced with the issue of hysterectomy. Unfortunately, sometimes this is the most suitable method that will allow you to get rid of pathologies, endometriosis, cancer, which are accompanied by heavy blood loss. Those who have undergone a hysterectomy (removal of the uterus) often panic. However, it's not all bad. In Western countries, it has long been practiced to remove the uterus of women after 45 years of age in order to avoid many diseases. In this matter, it is important to determine what method will be used for removal. There are several, but in this article we will talk about laparoscopic hysterectomy.
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What is a laparoscopic hysterectomy?
Laparoscopic hysterectomy is the removal of the main female organ (uterus) using a laparoscope.
According to practicing surgeons, this method of removal is the most gentle and has a minority of complications. Why choose this particular method for such a complex operation?
- Laparoscopy has minimal invasive consequences;
- The operation is almost painless;
- Does not entail adhesive processes;
- It leaves almost no scars on the patient’s abdomen (a huge plus, considering the aesthetic aspect);
- During laparoscopy, it is possible not to remove important organs along with the uterus, such as the cervix, for example;
- A short rehabilitation period is a definite plus, because after a laparoscopic hysterectomy, a woman, after a few hours, can already walk, be discharged from the hospital after 4 days, and return to her normal life within two weeks;
- Minimal risk of complications after surgery;
- Quick return to sexual life, namely, after 4 weeks.
In what cases is surgery performed?
The main reason for hysterectomy of the uterus is cancer of the organ itself or the appendages (ovary, cervix, tubes). In addition to this reason, there are a number of diseases for which laparoscopic hysterectomy is indicated.
- Rapidly developing uterine fibroids, especially during premenopause;
- Ectropion – inversion of the cervix into the vagina;
- Precancerous diseases of the uterus;
- Abnormal growth of the endometrium (adenomyosis);
- Stage 1 endometrial cancer;
- Organ prolapse (in this case, doctors tend to prefer vaginal hysterectomy);
- Multiple polyps;
- Endometrial atypia;
- Constant bleeding from the uterus, the cause of which is difficult to determine;
- Constant pain in the lower abdomen;
- Spikes.
Another case in which a hysterectomy will be performed is breast cancer. The uterus and breasts are closely connected. Therefore, there is a possibility of metastases going to the reproductive organs.
Contraindications for surgery
Despite the benefits of laparoscopic hysterectomy, this operation may not be suitable for everyone. Below is a list of contraindications for performing surgery using this method.
- A large amount of subcutaneous fat (not recommended for overweight women);
- Infections and inflammations in the acute phase;
- Abdominal adhesions;
- The presence of fluid in the peritoneum with a volume of 1 liter;
- Large size of the uterus from 16-20 weeks of pregnancy;
- Volumetric cysts on the ovaries.
In these cases, the woman is offered to choose another method of hysterectomy. This is usually removed vaginally.
How to prepare for the procedure?
Although the operation itself lasts less than an hour, preparation for it will take about two weeks. What does this include? First of all, this means passing all kinds of tests.
- Biochemistry;
- Group and Rhesus;
- Hepatitis;
- Syphilis;
- Coagulability;
- Glucose level.
Urine to determine sugar in the body.
In addition to these tests, you will also need to undergo the following procedures:
- Vaginal smear;
- Fluorography;
- Cardiogram of the heart;
- Ultrasound of the organ;
- Colposcopy of the cervix;
- Additional consultation with specialists such as a therapist, endocrinologist, cardiologist.
If a patient is prescribed laparoscopic hysterectomy for fibroids, she will first undergo curettage to send the material for histology.
A day before surgery, a woman should prepare her body. First, remove all pubic hair. The day before a hysterectomy, it is better for a woman not to eat. You should have a bowel movement in the morning.
Upon arrival at the hospital, the patient will be given a special pre-operative form that she will need to fill out. Next, the woman is sent to the operating room.
Procedure
Laparoscopic removal is performed using a special laparoscope apparatus. The woman is given anesthesia, which leads to general anesthesia. The operation then proceeds according to the points below.
- The surface of the abdomen is treated with special antiseptics for disinfection.
- Several incisions are made in the peritoneum to insert instruments. First, carbon dioxide is released to separate the peritoneal walls from the organs. This expands your horizons.
- Then a laparoscope with a video camera is inserted, which displays the image on the screen.
- A manipulator is inserted into the next incision, which is used to perform all the actions of excision and removal of the organ. To do this, first the ligaments are cut off, the vessels are cauterized, then the uterus is cut off and removed through the vagina. If the organ is too large, it is crushed inside and then removed.
- Afterwards, the vessels are ligated and the peritoneum is examined for the presence of postoperative blood and lymphatic fluid.
- Eliminate carbon dioxide and remove all instruments.
- Sutures are placed at the insertion sites of the manipulators.
Such an operation can last 15 minutes, or maybe 1.5 hours. It all depends on the extent of the disease and the diagnosis leading to laparoscopic hysterectomy.
The procedure for performing the operation is shown in the picture.
Recovery period after the procedure
Immediately after the operation, the woman remains in the hospital for an average of about a week. Doctors monitor the patient's condition all the time. The duration of the recovery period after laparoscopic hysterectomy depends on age, the course of the operation and the volume of removed organs.
On the first day after surgery, the woman will feel pain in the lower abdomen. This is normal. To relieve pain, a woman may be prescribed analgesics. If the pain is very severe, she may even be prescribed narcotic painkillers.
Despite the pain, the patient should begin to walk after a few hours. Physical activity helps prevent thrombophlebitis.
After laparoscopy, the woman is required to wear a special bandage and elastic stockings. This type of shapewear will need to be worn for about two weeks. You cannot remove it yourself. The doctor makes the decision.
Do not forget about the strictest antiseptic treatment. At the hospital, the medical staff does this regularly. During home care, the patient will also treat the stitches with special solutions.
After a hysterectomy, it is common to experience some spotting. This phenomenon should not scare you. Use pads during your discharge period. This usually takes 2-3 weeks.
As for food, there is also a postoperative diet. On the first day after a laparoscopic hysterectomy, you can only drink liquids. On the second day it is better to eat pureed food. And in the future, you can include familiar dishes in your menu, but do not get carried away with fried and smoked foods. Prohibition on strong drinks, canned food, and baked goods.
Prohibitions after hysterectomy:
- Sports, physical activity;
- Sex during the first 4-6 weeks;
- Lifting weights weighing more than 3 kg;
- Visiting saunas, swimming pools, ponds;
- Don't take baths.
Possible consequences and complications
This operation entails consequences and complications in only 1% of 100% of women undergoing surgery. What phenomena does this 1% include?
- Injury to internal organs;
- When the peritoneum is punctured, vascular damage occurs;
- Spikes;
- Infectious nature of complications;
- Special reactions to carbon dioxide.
Is pregnancy possible after surgery?
A hysterectomy involves removing the uterus. The uterus is the organ in which the child is born. If there is no uterus, then there can be no talk of pregnancy. After the operation, the woman does not even menstruate.
If a woman dreams of having a child after such an operation, then the only way out for her may be surrogacy or adoption of a child from an orphanage.
Price
Prices for laparoscopic hysterectomy depend on the clinic and the city in which the operations are performed. Below are three centers that perform such operations.
Indeed, removal of the uterus using laparoscopy is more expensive than other methods. But the patient overpays for the fact that the method will cause minimal consequences and complications.
So, if your doctor has ordered a hysterectomy, it would be wise to have it done by laparoscopy. This method has proven itself well and has only positive reviews.
Found 92 clinics offering hysterectomy services
What is the price for hysterectomy in Moscow
Prices for hysterectomy in Moscow from 20,700 rubles. up to 590881 rub..
Removal of the uterus: reviews
Patients left 3,818 reviews of clinics that offer hysterectomy surgery
What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus. With complete removal, the entire organ is removed, with partial removal, the cervix is left untouched. In a total hysterectomy, one or both ovaries and fallopian tubes are removed.
Removal can be done laparoscopically, robotically, or through the vagina. If the uterus is large or the doctor needs to check the condition of other organs of the lower abdomen, then removal occurs through open access through the abdominal wall.
In what cases do they resort to intervention?
Removal is resorted to in the following cases:
- Oncological diseases of the uterus, cervix or ovaries
- Myoma,
- Uterine prolapse
- Endometriosis,
- Chronic pain
- Adenomyosis.
In the absence of oncology, removal is resorted to only after unsuccessful conservative treatment.
How to prepare for removal?
Before the operation, the doctor will conduct tests and studies: the results of which may affect the tactics of surgical treatment:
- Cytology of the cervix,
- Endometrial biopsy,
- Ultrasound of the pelvic organs.
Immediately before the intervention, an enema and vaginal toilet will be performed, an injection of antibiotics and other medications will be given.
How is everything going?
Removal is performed under general anesthesia. The procedure usually lasts from one to two hours. Before starting, the bladder is emptied using a catheter. The type of incisions depends on the indications and can be minimal with laparoscopic techniques and large with abdominal access. The surgeon will separate the uterus from surrounding organs, tissues and blood vessels. If necessary, he may remove the ovaries or fallopian tubes.
What to expect after removal?
After the operation, doctors will monitor the patient in intensive care:
- Control pain syndrome
- Prevent the possibility of bleeding and infection.
You will need to spend two or more days in the hospital using sanitary pads to collect blood and other secretions.
It will take about six weeks to return to normal. If the ovaries were removed, the woman will go through menopause. If they are preserved, menopause may occur earlier. It is recommended to abstain from sex and avoid lifting heavy objects for six weeks after the intervention. A woman will never be able to get pregnant.
What complications can there be?
The intervention is safe, but, as with any serious operation, there are risks of complications:
- Infection, bleeding,
- Thrombosis,
- Reaction to anesthesia
- Damage to the urinary tract, rectum or other pelvic organs.
- Early onset of menopause.
- Increased risk of cardiovascular disease and metabolic syndrome before age 35,
- Urinary incontinence,
- Vaginal fistula, vaginal prolapse,
- Chronic pain.
What results are achieved?
Relief of symptoms can significantly improve the quality of life and maintain it during recovery from dangerous diseases. On the other hand, women may experience grief and possibly depression due to loss of fertility.
Gynecological pathologies- a very “popular” problem among the fairer sex, which, unfortunately, cannot in any case be solved with the help of conservative therapy, particularly in such situations when it comes to cancerous tumors in the uterine cavity or other organs of the genitourinary area.
In such circumstances, the only effective method of getting rid of pathology is an intervention to remove the organ, which is considered one of the most applicable in surgical gynecology.
Surgical intervention to remove the female reproductive organ is a very strong test for every woman, because this manipulation not only causes severe pain, but is also a psychological blow that entails emotional oppression and a feeling of inferiority.
Many people believe that life after the operation of excision of the uterus is no longer full in terms of sexual desire and contact, but any patient simply must understand that the operation performed stops the sadly promising development of cancer, thus saving her life.
Who needs surgery to remove the uterus, how many types of intervention are there in modern gynecology, what is the preparation and prognosis for the results of surgical manipulation to remove the uterus?
Such questions are quite popular among representatives of the fairer sex who have crossed the 40-year mark, who are at risk of developing pathologies that require surgical treatment.
Indications for hysterectomy
In surgical gynecology, the procedure for amputation of the uterus has its own name - hysterectomy; it is indicated in situations where medical therapy has not had a positive result or when the patient sought help too late.
In some European countries, hysterectomy is performed even on those patients who have a hereditary tendency to develop uterine cancer or according to the wishes of a woman who does not want to have her own children and is afraid of developing complex gynecological pathologies.
For representatives of the fairer sex of our country, the reproductive function is very significant, so it is very rare to meet a patient who, without a doctor’s recommendation, would have the reproductive organ removed.
Hysterectomy may be indicated by a doctor for such disorders or diseases of the reproductive and genitourinary areas as:
![](https://i1.wp.com/woman-centre.com/wp-content/uploads/2018/01/obshhie-patolgoii.jpg)
Excision of the uterus is prescribed by oncologists only in extreme cases, because its implementation completely deprives a woman of reproductive quality. This measure is carried out for fibroids and other complex pathologies.
Myoma
Intervention to remove fibroids in the uterine cavity is carried out in case of significant growth of miasmatic tumors, large volumes of tumors and other complex conditions, if it is not possible to perform myomectomy or embolization.
Excision of the uterus for fibroids– the result may not always please the patient, since during the operation sometimes not only the uterus is removed, but also its appendages, fallopian tubes, and in 40% of situations the ovaries are also excised.
The term fibroid in medical practice refers to a benign neoplasm of a muscle and connective structure.
Often the formation develops in the uterus. Fibroids come in all sizes.
When the myomatous nodes of the tumor are more than 6 cm and the uterus is of significant size, similar to the 12th week of gestation, then such a benign neoplasm is large.
In order to get rid of fibroids, one of the following types of intervention may be indicated: laparoscopic or abdominal myomectomy, intervention to excise the reproductive organ.
Hysterectomy for this pathology is indicated as a last resort, when other methods have failed, or the patient’s age category is over 40 years.
The process of growth of the mucous layer of the uterine body into the ovaries, peritoneum, fallopian tubes and other areas in which its presence should not be is called in medicine.
This pathology is associated with inflammation of nearby organs, on which the internal uterine layer grows, painful manifestations during critical days, and vaginal discharge.
In some cases, with endometriosis, it becomes necessary to perform uterine excision.
However, this measure is not always effective in completely eliminating the disease.
Hysterectomy of the uterus for this pathology is indicated for patients who do not want to have more children.
In order to eliminate the threat to the patient’s life, specialists may prescribe a hysterectomy.
In such a situation, radical intervention is often carried out.
The cervix, upper fragment of the vagina, uterus, fallopian tubes, ovaries and nearby tissues, and lymph nodes are excised.
After a hysterectomy and excision of a malignant neoplasm, the patient is prescribed a course of radiation treatment and radiotherapy.
By the time the operation is performed, it can predetermine the further formation of malignant growth in the body.
Necrosis of fibromatous nodes
The most severe deviation of uterine fibroids, associated with a lack or absence of life-sustaining nutrition of fibromatous cells with the prospect of developing painful sensations and swelling. Palpation of the affected area increases pain, provokes vomiting, fever and irritation of the peritoneum.
Penetration of infection causes more significant manifestations of pain. The type of operational measure is determined purely individually. The result of the operation is related to the age category of the patient and her general state of health.
Prolapse and prolapse of the uterus
Providing factors for this deviation are considered to be weakness of the muscles in the pelvis and peritoneum. The formation of the disease is helped by inflammation, endocrine disorders, numerous births and physically hard work.
If there is no expected result from treatment at the initial stage of the disease, a radical method becomes necessary - hysterectomy. excision implies two ways of developing events:
- Uterine and vaginal removal;
- Fragmental excision of the vagina, allowing sexual activity.
Is surgery really necessary?
The advisability of performing a surgical intervention aimed at excision of the uterine appendages and the uterus itself is determined exclusively by the doctor
Preparing for surgery
To be fully prepared for surgery, the surgeon must stock up at least 0.5 liters of blood, which, if necessary, can be transfused to the patient.
If the patient has second or third degree iron deficiency, then before the intervention she receives a blood transfusion.
If atrophic colpitis is diagnosed, the patient undergoes a course of therapy aimed at normalizing the damaged tissues.
Those with a known tendency to form blood clots are prepared with special attention.
Such patients use drugs to reduce the development of blood clots, regulate blood density, and bring arteries and blood vessels to normal tone.
If a tendency to varicose veins is noticed, the patient should undergo an ultrasound examination of the legs. To avoid infection during surgery, antibiotics are prescribed and administered to the patient under anesthesia.
In practice, there is an inapplicable rule in surgery: before any even the slightest significant surgical procedure is performed, each patient must certainly receive advice from specialists such as a phlebologist and a vascular surgeon.
Analyzes
Since the operation of excision of the uterus and ovaries is quite difficult, after its implementation many complications appear, therefore, the person being operated on must undergo tests to determine the condition of other organs, blood and the rest:
![](https://i2.wp.com/woman-centre.com/wp-content/uploads/2018/01/mazok-na-floru.jpg)
Bowel preparation
The following activities need to be completed and prepared:
![](https://i1.wp.com/woman-centre.com/wp-content/uploads/2018/01/prinadlezhnosti-dlya-klizmy.jpg)
Moral preparation
Removal of the main reproductive organ from the female body is a powerful stress, in particular for young women. The surgeon needs to explain why the intervention is necessary and how it will be carried out.
And the patient’s concerns about a sexually active life after a hysterectomy are unfounded, because the elimination of some organs of reproductive function does not affect the degree of libido.
Progress of the operation
In gynecological practice, for the most part, the method of laparoscopic or assisted vaginal subtotal or total removal of the uterus is used, leaving appendages on at least one side (when possible), which, without taking into account other advantages, helps to reduce the degree of manifestation of post-hysterectomy sensations.
The operation with a combined access consists of 3 stages - two laparoscopic and vaginal.
The initial stage consists of:
![](https://i0.wp.com/woman-centre.com/wp-content/uploads/2018/01/udalenie-matki-laparoskopicheskim-metodom.jpg)
The next stage is presented in:
- dissection of the outer vaginal wall;
- passing through the vesicouterine ligament, following the retraction of the bladder;
- making an incision in the mucous membrane of the deep vaginal wall and applying sutures to stop bleeding on it and on the peritoneum;
- applying binding linen or silk threads to the uterosacral and cardinal ligaments, as well as to the uterine veins to intersect these tissues;
- pulling the uterus closer to the wound and cutting it off or dividing it into parts (if it is significant) and removing them one by one.
- Applying stitches to the stumps and to the vaginal mucosa.
At the third stage laparoscopic monitoring is performed again, at which time minor bleeding capillaries (if any) are ligated and the pelvic space is drained.
Excision of the uterus- This is not only the removal of the affected organ, since hysterectomy is often associated with surgery on other anatomical tumors.
Depending on the volume of intervention performed, hysterectomy is divided into:
![](https://i2.wp.com/woman-centre.com/wp-content/uploads/2018/01/gisterektomiya-vidi.jpg)
According to the method by which access is provided, the following types of removal of the reproductive organ are distinguished:
- laparotomy hysterectomy(the uterus is removed through a longitudinal or transverse section of the abdominal wall)
- organ removal laparoscopically(a small number of punctures, from 2 to 4, in the abdominal wall, through which the laparoscope and devices are introduced)
- vaginal hysterectomy– passage to the diseased organ is made through the vaginal cavity.
Radical hysterectomy is performed in the case of a malignant neoplasm of the uterus involving the cervix in the pathological process or in the case of a malignant tumor of the cervix.
Total removal is required for large uterine fibroids, growing endometriosis, associated diseases (formations) of the uterus and cervix, and in addition for women over 45.
In other situations, the main reproductive organ is amputated.
Whether appendages must be removed or not - this issue is often decided at the time of resection, when the organs can be seen. The method by which admission will be made largely depends on the operating surgeon. But in some situations, a woman can be given the right to choose.
The advantages of abdominal removal, include democratic prices, confidence, reduced risk of intraoperative complications, the possibility of its implementation in almost every women's department. The disadvantages include: a significant scar on the abdomen, a long stay in the hospital (10 days), a long recovery period (4 - 6 weeks).
The benefits of laparoscopic hysterectomy include: discharge after 5 days, short recovery period (2 - 4 weeks), no visual effect (no scars), reduced risk of adhesions in the abdomen, and as a result, reduced likelihood of adhesive pathology with a pronounced painful syndrome.
The disadvantages include: A very expensive operation, the prospect of switching to laparotomy, is carried out exclusively in large cities (medical centers and institutes).
Vaginal hysterectomy is easily tolerated, there are no scars on the abdomen, the recovery period is shorter, 3 - 4 weeks, there is almost no painful feeling after surgery. Disadvantages include a complicated technique and a high risk of intraoperative complications.
Abdominal surgery
In order to gain access to the uterus during abdominal surgery, the surgeon makes an incision in the abdominal wall. After completing all stages of the hysterectomy, the doctor sews up the hole and applies a sterile, clean bandage.
Despite the fact that this type of removal is used quite often, it has a number of disadvantages.
Among which: significant trauma for the patient, a large scar on the abdomen, which remains after this type of surgery to remove the female reproductive organ.
The duration of this type of hysterectomy is approximately 40 minutes to 2 hours.
Laparoscopic
Gentle hysterectomy is a laparoscopic method of performing the intervention.
This type of surgery is performed without significant incisions on the abdomen.
To perform laparoscopic surgery, medical instruments and devices are used:
- First, gas is injected into the abdominal space through a gynecological tube called a cannula. This is required so that the wall of the peritoneum rises above the organs, and the surgeon has access to the organ to be removed.
- Then the surgery itself begins. In order to remove the uterus itself or other nearby organs, the surgeon inserts tubes into the abdominal space through small incisions on the abdomen. Through which a video camera and surgical devices are lowered into the cavity.
Laparoscopic excision of the uterus lasts 1.5-3.5 hours. The property of this method is that the incision is small, and accordingly there are no consequences in the form of a scar on the stomach.
Vaginal
The manipulation is a convenient option, does not require sutures, and does not leave scars. This type of hysterectomy is characterized by rapid physical and mental recovery.
Despite the many advantages, this type of surgery has a number of contraindications.
The operation is prohibited when:
- The uterus is of significant volume;
- A neoplasm of a malignant nature is present;
- There is an inflammatory phenomenon;
- Previous cesarean section;
- Associated diseases have been identified.
Anesthesia
For the most part, endotracheal joint anesthesia is used. Many patients testify that it is well tolerated and does not cause headaches.
The patient is awakened after 15-20 minutes, immediately after performing a similar operation, such as laparoscopic removal of the uterus.
Postoperative time with appropriate anesthesia leads to excellent results after surgery: there is no painful sensation, there is a slight inconvenience that disappears after 2 days. In some cases, nausea may occur, but this is eliminated "Metoclopramide."
For the first 24 hours, you are allowed to drink only water. By the evening of the day of surgery, you can already rise and stand on your feet. The next day, you can eat food that slightly irritates the gastrointestinal tract: liquid cereals, meat broths, fermented milk products.
Discharge takes place on the second day after the amputation, and the sick leave ends after 30 days. After which the woman can go to work without difficulty, but with a restriction of heavy physical activity for 30 days.
The sutures are removed on the 5th postoperative day.
After surgery, complications are possible, which occur extremely rarely: This is injury to nearby organs with a trocar, bleeding from incompletely ligated veins, subdermal emphysema.
All this can be prevented if you strictly follow the technique of the event and carefully carry out visual inspection of the abdominal space.
Operation duration
The duration depends on the method of admission, the type of excision and the volume of surgical intervention, the presence of adhesions, the volume of the uterus and a large number of other factors. However, the average duration of the entire operation is usually 1-3 hours.
The basic technical principles of intervention to remove the uterus with laparotomy and laparoscopic access are the same.
The fundamental difference is that in the first case, the organ with or without appendages is removed through an incision in the abdominal wall, and in the second, the organ is removed using an electromechanical device (morcellator) and is distributed in the abdominal space into parts, which are then removed using a laparoscopic tube (tube). ).
Postoperative period
It is no secret that the time interval that lasts from the day of surgical removal until the restoration of work capacity and excellent health is called the postoperative period. Hysterectomy is also characterized by such a period.
The time after amputation is divided into 2 “sub-periods”:
- Early;
- Late postoperative period.
During the early postoperative period, the patient is in a hospital setting under the supervision of doctors. Its duration is related to surgical admission and the general condition of the patient after surgery.
After a hysterectomy of the uterus and/or appendages, which was performed either by an incision in the vagina or through an incision in the abdominal wall, the patient stays in the women’s department for 8–10 days, and it is at the end of this period that the sutures are removed.
After laparoscopic surgery to remove the uterus, the patient is discharged after 3 to 5 days.
The first day after surgery
The initial postoperative days are especially sensitive:
![](https://i1.wp.com/woman-centre.com/wp-content/uploads/2018/01/posle-operacii.jpg)
Treatment after surgery
Treatment after surgery is as follows:
![](https://i1.wp.com/woman-centre.com/wp-content/uploads/2018/01/antibiotiki-ukoli.jpg)
The early postoperative period is considered normal when there are no complications.
Recovery and rehabilitation
The rehabilitation and recovery time after surgery to remove the uterus is the most difficult when it comes to abdominal surgery. Postoperative time is presented as a week, and the sutures from the scar are removed on the sixth or seventh day.
Abdominal or abdominal surgery to remove the female reproductive organ is required for uterine cancer, significant fibroids, or in situations of suspected ovarian cancer.
Such a surgical intervention makes it possible to more accurately assess the degree of disease of the genital organs, but it increases and aggravates the recovery period after excision of the reproductive organ.
The method of vaginal removal of a diseased organ is practiced by cutting the deep walls of the vagina. The patient at this moment is located in the gynecological chair.
Such a surgical procedure is carried out in the absence of the slightest suspicion of any form or type of oncology, and when the uterus is small. Vaginal ectomy is complicated by the fact that it is performed blindly and for this reason, the occurrence of postoperative health complications becomes likely.
Nutrition
The patient’s diet after surgery to remove the uterus must include the principle of a gentle regime: the exclusion of aggressive or irritating foods to the mucous membrane of the gastrointestinal tract.
The following foods must be avoided:
- confectionery products,
- rich coffee and tea,
- cheese and cottage cheese,
- chocolate,
- white bread, buns.
To “start” intestinal functions after surgical manipulation, you need to eat in small portions, but often - 5-7 times a day. The daily volume of water consumption must be increased to 2-4 liters.
The consumption of foods that have a laxative effect is required: all types of cereals, meat and vegetable broths, fermented milk products.
Main instructions- strictly follow the diet prescribed by the attending physician, both in the initial days after the end of the operation and during the rehabilitation period.
Physical exercise
Operated patients are prohibited from lifting large bags or other heavy items for about a month and a half after discharge from the hospital. The timing is similar for the start of sexual activity.
Visiting the pool for women who have undergone surgery to remove the uterus is permissible no earlier than 6-8 weeks after hysterectomy.
Despite the fact that the sutures dissolve in the body within 6 weeks, surgeons recommend starting physical exercise or going to a fitness center only six months after abdominal surgery, when a scar has formed. The patient’s leading specialist will explain a lot about light exercise classes.
After the intervention, the period of bringing the body back to normal and recovery becomes very important, so each woman receives the necessary recommendations from a gynecologist or surgeon, which will provide a preventive option against the occurrence of complications, will quickly recover and return to normal after the operation.
Among the fundamentally important tips, the following become mandatory:
![](https://i2.wp.com/woman-centre.com/wp-content/uploads/2018/01/devushka-i-znak-stop.jpg)
The attention and care of loved ones undoubtedly contributes to rapid rehabilitation.
When a woman, after an operation, is subject to psycho-emotional depression and is not able to overcome her own difficulties on her own, she needs outside help in the form of psychological recovery, conversations with a psychologist, and most importantly, the care and love of family members.
The hysterectomy slightly changes the patient’s usual lifestyle.
In order to ensure a quick and successful recovery and recovery after surgery, doctors inform their patients about rehabilitation methods and specific steps on the path to recovery.
Postoperative bandage
If the early postoperative period proceeded without any negative changes, then after the patient’s stay in the hospital has passed, she should immediately take care of her own health and prevent future consequences.
Bandage she is a very good helper in this matter. This device is a help during the final postoperative period.
It is especially acceptable for those women who are classified in the premenopausal age category and have a history of numerous pregnancies and childbirths with aggravated conditions.
There are a number of models of such a support corset; it is necessary to select only the option in which a woman who has undergone surgical surgery does not feel any discomfort or inconvenience.
The main condition when selecting a corset bandage– its width boundaries must be located higher than the scar, at least 100 mm above and below (in the event that a laparotomy was performed in the area below the middle of the abdomen).
Pros and cons of the operation
Positive aspects still exist after surgery to remove the uterus. Before deciding on this surgery to excise the uterus with or without appendages, you need to soberly evaluate all the advantages and disadvantages.
The positive properties of hysterectomy include:
- absence of menstrual flow and the emergence along with them of the question of the need to use protective equipment;
- no pain or bleeding, which significantly complicate the quality of life;
- guarantee against uterine cancer(no organ – no threat) weight loss, waist reduction.
The negative points include:
![](https://i2.wp.com/woman-centre.com/wp-content/uploads/2018/01/kak-vygljadit-shov.png)
Uterine artery embolization - as an alternative
is perceived as an innovative and modern technology, despite the fact that it began to be actively used back in the 70s of the 20th century.
The principle of embolization is presented in the form of inserting a catheter into the femoral vein, then the tube reaches the uterine vein (under observation by means of radiography), and then the area where the arteries and veins branch from it, which provide blood supply to the fibroid nodes.
The introduction of specially created medications through a catheter creates a blockage of blood supply in small capillaries, leading to myomatous neoplasms and disrupts blood circulation in them.
Embolization of the uterine arteries is becoming an excellent option for replacing surgical intervention to remove uterine fibroids, since it helps stop the growth and development of nodes, and even minimize their size or completely dry out.
A similar manipulation is carried out in the presence of developing uterine fibroids up to 20 weeks, however, in cases where pathologies of the ovaries and cervix are not observed, and in patients in whom it is established that fibroids are developing.
In addition, uterine artery embolization is prescribed for uterine bleeding, which can cause the patient’s death.
And yet, situations arise when a hysterectomy due to fibroids becomes impossible to replace in any other way:
- submucosal uterine fibroids;
- significant volumes of uterine fibroids;
- aggravation of fibroids by the growth of the inner layer of the uterus and neoplasms of the ovaries;
- continuous bleeding, which can lead to iron deficiency and anemia;
- developing and growing neoplasm.
In which cases?
At its core, embolization of the reproductive organ and nearby tissues is prescribed when the following signs and conditions appear:
![](https://i1.wp.com/woman-centre.com/wp-content/uploads/2018/01/ema-na-snimke.jpg)
Similar to any medical procedure, surgical manipulation to remove the uterus has characteristic contraindications such as:
- The size of fibroid formations is too large, when the uterus is enlarged in size when compared with the 25-week state of gestation;
- The presence of a large number of neoplasms of different sizes;
- Inflammatory vaginal diseases;
- Insufficient kidney function;
- The state of bearing a child;
- Myoma blood supply disorder;
- Presence of parallel oncology of the external genital organs, etc.
As usual, if there are contraindications, venous occlusion is performed, which is performed using the laparoscopic method.
In some cases, occlusion has only a temporary property; it is in such a situation that the blood supply is blocked for a certain time interval, thanks to specially created blood clots, gelatin-containing medications and other devices and components. Still, temporary occlusion is used quite infrequently.
Consequences and complications
After removal of the uterus, the following complications may occur:
- Painful feeling after hysterectomy surgery, may be detected due to the formation of adhesions or blood loss. These signs quite often occur on the first day after the operation.
- In addition, thrombosis of the deep vessels of the legs may become a consequence of the intervention., all kinds of urination disorders, fever, suppuration and inflammation of the stitching site, bruises and extensive hematomas.
- In addition, a decrease in the degree and strength of sexual desire is likely and the occurrence of dryness in the vaginal cavity, however, such complications are more an exception than an axiom.
- Women after surgery become significantly prone to such pathologies as osteoporosis and atherosclerosis.
All these complications and negative manifestations significantly lengthen the time of rehabilitation and recovery. Quite often, after removal of the uterus, women experience all the signs and symptoms of menopause.
Cost of the operation
Unambiguously answer the question “what is the cost of this operation?” very difficult. Often the cost depends on many reasons.
Among the main ones:
- area of permanent residence of a woman,
- class of hospital and specialists,
- scale of hysterectomy and its duration,
- hospital conditions.
For example, laparoscopic extirpation in private medical institutions will cost the patient 16000-90000 rubles , and for the vaginal method of removing the reproductive organ you will have to pay in the area from 25,000 to 85,000 rubles.
Removal of the uterus using the laparoscopic method is indicated in the following cases:
- multiple myomas (fibroids) of the uterus;
- hyperplastic process of the endometrium that is not amenable to conservative therapy;
- adenomyosis;
- the presence of various neoplasms in the uterine cavity (cancer, multiple or atypical polyps) and fallopian tubes;
- emergency postpartum removal of placenta accreta;
- simultaneous removal of the uterus and ovaries in case of progression of the purulent inflammatory process;
- recurrent bleeding of unknown etiology.
The laparoscopic method involves the removal of organs in several options:
- Supravaginal amputation of the uterus. This method involves removing the body of the uterus without the cervix. The appendages also remain in place. A similar operation is indicated, in particular, for large fibroids, adenomyosis, and endometrial hyperplasia. Removal of uterine fibroids using the laparoscopic method is a widely used type of surgical treatment.
- Extirpation of the uterus (total hysterectomy). Removal of the uterus along with the cervix. The operation is indicated for endometrial cancer. The ovaries and tubes remain unaffected.
- Hysterosalpingo-oophorectomy. It involves the removal of not only the body of the uterus, but also the fallopian tubes and ovaries. Removal of reproductive organs is indicated for extensive inflammation, peritonitis, malignant tumors, and bilateral purulent inflammation of the ovaries. Radical surgery is performed only in exceptional cases when there is a direct threat to life.
- Radical hysterectomy. This procedure involves removing the uterus and other organs of the reproductive system, fatty tissue, and inguinal lymph nodes in order to prevent the spread of the oncological process. Cancer of the reproductive system is the main indication for such surgery.
Despite the benefits of laparoscopic hysterectomy, this operation may not be suitable for everyone. Below is a list of contraindications for performing surgery using this method.
- A large amount of subcutaneous fat (not recommended for overweight women);
- Infections and inflammations in the acute phase;
- Abdominal adhesions;
- The presence of fluid in the peritoneum with a volume of 1 liter;
- Large size of the uterus from 16-20 weeks of pregnancy;
- Volumetric cysts on the ovaries.
In these cases, the woman is offered to choose another method of hysterectomy. This is usually removed vaginally.
Although the operation itself lasts less than an hour, preparation for it will take about two weeks. What does this include? First of all, this means passing all kinds of tests.
- Biochemistry;
- Group and Rhesus;
- Hepatitis;
- Syphilis;
- Coagulability;
- Glucose level.
Urine to determine sugar in the body.
In addition to these tests, you will also need to undergo the following procedures:
- Vaginal smear;
- Fluorography;
- Cardiogram of the heart;
- Ultrasound of the organ;
- Colposcopy of the cervix;
- Additional consultation with specialists such as a therapist, endocrinologist, cardiologist.
If a patient is prescribed laparoscopic hysterectomy for fibroids, she will first undergo curettage to send the material for histology.
A day before surgery, a woman should prepare her body. First, remove all pubic hair. The day before a hysterectomy, it is better for a woman not to eat. You should have a bowel movement in the morning.
Upon arrival at the hospital, the patient will be given a special pre-operative form that she will need to fill out. Next, the woman is sent to the operating room.
Laparoscopic removal is performed using a special laparoscope apparatus. The woman is given anesthesia, which leads to general anesthesia. The operation then proceeds according to the points below.
- The surface of the abdomen is treated with special antiseptics for disinfection.
- Several incisions are made in the peritoneum to insert instruments. First, carbon dioxide is released to separate the peritoneal walls from the organs. This expands your horizons.
- Then a laparoscope with a video camera is inserted, which displays the image on the screen.
- A manipulator is inserted into the next incision, which is used to perform all the actions of excision and removal of the organ. To do this, first the ligaments are cut off, the vessels are cauterized, then the uterus is cut off and removed through the vagina. If the organ is too large, it is crushed inside and then removed.
- Afterwards, the vessels are ligated and the peritoneum is examined for the presence of postoperative blood and lymphatic fluid.
- Eliminate carbon dioxide and remove all instruments.
- Sutures are placed at the insertion sites of the manipulators.
Such an operation can last 15 minutes, or maybe 1.5 hours. It all depends on the extent of the disease and the diagnosis leading to laparoscopic hysterectomy.
The procedure for performing the operation is shown in the picture.
Immediately after the operation, the woman remains in the hospital for an average of about a week. Doctors monitor the patient's condition all the time. The duration of the recovery period after laparoscopic hysterectomy depends on age, the course of the operation and the volume of removed organs.
On the first day after surgery, the woman will feel pain in the lower abdomen. This is normal. To relieve pain, a woman may be prescribed analgesics. If the pain is very severe, she may even be prescribed narcotic painkillers.
Despite the pain, the patient should begin to walk after a few hours. Physical activity helps prevent thrombophlebitis.
After laparoscopy, the woman is required to wear a special bandage and elastic stockings. This type of shapewear will need to be worn for about two weeks. You cannot remove it yourself. The doctor makes the decision.
Do not forget about the strictest antiseptic treatment. At the hospital, the medical staff does this regularly. During home care, the patient will also treat the stitches with special solutions.
After a hysterectomy, it is common to experience some spotting. This phenomenon should not scare you. Use pads during your discharge period. This usually takes 2-3 weeks.
As for food, there is also a postoperative diet. On the first day after a laparoscopic hysterectomy, you can only drink liquids. On the second day it is better to eat pureed food. And in the future, you can include familiar dishes in your menu, but do not get carried away with fried and smoked foods. Prohibition on strong drinks, canned food, and baked goods.
Prohibitions after hysterectomy:
- Sports, physical activity;
- Sex during the first 4-6 weeks;
- Lifting weights weighing more than 3 kg;
- Visiting saunas, swimming pools, ponds;
- Don't take baths.
Direct indications for removal of the uterus are the following cases:
- The presence of malignant tumors of the body and/or cervix. In this case, hysterectomy is the only effective treatment. If metastases occur, in addition to surgery to remove the reproductive organ, radiation and chemotherapy are required.
- Myomatosis. Myoma is a benign neoplasm in the uterus. The disease can be expressed by the following symptoms: pain in the pelvis, heavy bleeding, anemia. In particularly advanced cases, removal of the uterus is the only possible treatment method.
- Endometriosis. For some reason, the inner lining of the uterus begins to grow into the fallopian tubes, ovaries, and other peritoneal organs. If a course of conservative treatment and even surgery do not produce the expected results, a hysterectomy is prescribed.
- Profuse, constant bleeding from the vagina. If a course of conservative treatment is ineffective, removal of the uterus may be the only option.
Laparoscopic hysterectomy is often used due to the following advantages:
- Slightly traumatic. Surgery is performed through small incisions in the abdominal cavity. Thanks to this, the operation is easier to tolerate and there are practically no complications.
- Good cosmetic effect.
- Fast recovery period.
Good overview of the pelvic organs. The image is enlarged and displayed on the screen, allowing the surgeon to see everything he is doing. This is very important if endometriosis, adhesions, or cysts occur.
Laparoscopic hysterectomy is performed without large incisions in the abdomen. Laparoscopic instruments and a video camera are inserted into the abdominal cavity through small incisions. The doctor performs the manipulations, and the progress of the operation is displayed by the camera on the monitor screen. So that the doctor can clearly see what is happening, as well as access to the uterus, the abdominal cavity is filled with gas at the very beginning.
The laparoscopic method can be used in two options, which we will discuss in more detail later.
- Laparoscopically assisted vaginal hysterectomy. In this case, the operation is performed in combination of these two methods. First, laparoscopy is performed, the purpose of which is to separate adhesions, excise foci of endometriosis, remove the ovaries and uterine tubes, and intersect the upper portion of the ligamentous apparatus of the organ. After these manipulations, the doctor continues the operation through the vagina. Thanks to this course of the operation, injuries are reduced, the rehabilitation period will be easier, and fewer complications are observed. In addition, a good cosmetic effect is achieved, because there will be only a few small scars on the stomach, which will become invisible over time.
- Total laparoscopic hysterectomy. The essence of the operation is that the uterus is removed only by laparoscopic method. At the very beginning of the operation, the doctor makes incisions on the woman’s abdomen. Using a cannula, the abdominal cavity is filled with gas. Trocars are also inserted through the incisions, and through them a camera and special instruments are inserted into the abdominal cavity. During the operation, the surgeon cuts through the uterus. If necessary, crosses the ovaries and fallopian tubes, and also ligates the uterine arteries. To remove the removed fragments from the vagina, a small incision is made in the lower abdomen or an incision in the vagina. If there is an oncological process, the removal of the reproductive organ is carried out with nearby lymph nodes.
As a rule, laparoscopic operations are characterized by a low rate of complications. In rare cases, accidental injuries to the internal genital organs, blood vessels, the effects of gas injected into the abdominal cavity on the body, hematomas, and infections are possible.
Suture after hysterectomy
Removing the uterus using the laparoscopic method has several advantages:
- 1. Low morbidity.
- 2. High speed of surgical intervention.
- 3. Almost complete absence of cosmetic defects.
- 4. There is a high probability of admission to surgery for patients with chronic diseases of the heart and respiratory system.
- 5. Relatively short recovery time.
- 6. Relatively few possible postoperative complications.
Laparoscopic hysterectomy is a fairly serious surgical procedure. It is performed only if the patient has clear indications for hysterectomy. These include:
- malignant neoplasms;
- adenomyosis;
- multiple benign tumors of the uterus in combination with pathology of the cervical region of the organ;
- atypical and recurrent hyperplasia;
- a common form of external endometriosis, combined with pathology of the uterus and endometrium;
- endometrial polyposis.
All these diseases can lead to serious complications, therefore, when diagnosing them, laparoscopic removal of the uterus allows you to avoid dangerous consequences. To save the patient's life, the organ along with its appendages is removed. However, such interference also poses a certain threat. Surgery is contraindicated in the following cases:
- acute infectious diseases;
- severe general condition of the woman;
- large size of the uterus;
- decompensated chronic diseases;
- adhesions in the pelvis;
- large cystic formations on the organs being removed;
- free fluid exceeding 1 liter in volume in the pelvic cavity.
These contraindications can be considered relative. These diseases and pathological conditions are completely curable with conservative treatment.
Laparoscopic hysterectomy is the removal of the main female organ (uterus) using a laparoscope.
According to practicing surgeons, this method of removal is the most gentle and has a minority of complications. Why choose this particular method for such a complex operation?
- Laparoscopy has minimal invasive consequences;
- The operation is almost painless;
- Does not entail adhesive processes;
- It leaves almost no scars on the patient’s abdomen (a huge plus, considering the aesthetic aspect);
- During laparoscopy, it is possible not to remove important organs along with the uterus, such as the cervix, for example;
- A short rehabilitation period is a definite plus, because after a laparoscopic hysterectomy, a woman, after a few hours, can already walk, be discharged from the hospital after 4 days, and return to her normal life within two weeks;
- Minimal risk of complications after surgery;
- Quick return to sexual life, namely, after 4 weeks.
The main reason for hysterectomy of the uterus is cancer of the organ itself or the appendages (ovary, cervix, tubes). In addition to this reason, there are a number of diseases for which laparoscopic hysterectomy is indicated.
- Rapidly developing uterine fibroids, especially during premenopause;
- Ectropion – inversion of the cervix into the vagina;
- Precancerous diseases of the uterus;
- Abnormal growth of the endometrium (adenomyosis);
- Stage 1 endometrial cancer;
- Organ prolapse (in this case, doctors tend to prefer vaginal hysterectomy);
- Multiple polyps;
- Endometrial atypia;
- Constant bleeding from the uterus, the cause of which is difficult to determine;
- Constant pain in the lower abdomen;
- Spikes.
Another case in which a hysterectomy will be performed is breast cancer. The uterus and breasts are closely connected. Therefore, there is a possibility of metastases going to the reproductive organs.
Based on the results of preliminary studies, the doctor decides what volume the operation to remove the uterus will have and what is the best way to carry it out. Today there are the following main types:
- Removal of the reproductive organ above the vagina. During surgery, the body of the uterus is removed, but the cervix remains.
- Laparoscopically assisted vaginal hysterectomy. In this case, through laparoscopic access, the vessels and ligaments that supply the organ are crossed, after which the surgical intervention continues through the vagina.
- Laparoscopic hysterectomy. Surgical intervention is performed through laparoscopic access. The organ is cut off through the vagina and the vagina is sutured.
- General hysterectomy using laparoscopic method. In this case, the operation is performed through laparoscopic access, including cutting off the reproductive organ and suturing the vagina.
- Radical removal of the uterus. The reproductive organ, along with the cervix, lymph nodes and uterine tissue, is removed through laparoscopic access. As a rule, such a radical operation is performed for oncology of the female genital organs (body and cervix, ovaries, endometrium).
At first, severe pain and low-grade fever are considered normal. Doctors may also leave a catheter in the bladder to drain urine for 1-2 days.
The postoperative suture can be either very small after laparoscopy or quite large after abdominal hysterectomy. In any case, it requires careful care until it heals completely.
The first time after surgery, the suture must be treated with special means to avoid infection. You can take a shower without fear, but taking a bath is prohibited. The seam is carefully washed with liquid soap and washed off with water.
Gradually, a scar will form at the incision site. Sometimes the skin itches a little, it can be lubricated with a softening cream or lotion. A slight burning sensation or numbness in the scar area is normal and usually goes away after a couple of months.
A slight increase in temperature in the first days after surgery is normal. If necessary, the doctor may prescribe antibiotics. After discharge, the temperature may also remain elevated, but not more than 37.5 °C. If it exceeds this mark, you should consult a doctor.
Too many benign tumors. These include fibroids, in which the nodes grow and prevent neighboring organs from functioning normally. In addition, such formations cause heavy bleeding. The presence of malignancy of malignant or benign tumors not only of the uterine body, but also of its cervix, as well as the fallopian tubes and ovaries.
Internal injuries that are serious, cannot be treated surgically, and pose a threat to the patient’s life. Tears that appeared during the process of delivery (during natural childbirth or performed by cesarean section), breakthrough bleeding.
In addition, complete removal can be carried out when there is no threat to the patient's life. Indications for complete removal of the uterine body here may be the following: severe pain in this organ, vaginal or uterine bleeding, which recurs very often, as well as myomatous nodes.
In such situations, specialists give the patient the right to choose whether to continue living with constant discomfort and pain or decide to have a hysterectomy. Sometimes, this operation can save a woman's life.
After a hysterectomy, you may experience severe pain. They appear due to bleeding or the formation of adhesions. In what cases can this happen? Most often, these symptoms occur during the first few days after removal. Among other things, the consequences of uterine amputation include impaired urination, the appearance of hematomas, and thrombosis of the veins in the legs. The stitches may fester.
Any of these complications affects the recovery process after hysterectomy. Very often, patients may experience signs of menopause.
Also, after removal, dryness sometimes appears inside the vagina, and the level of sexual desire for a partner decreases. But such phenomena were recorded in only 5% of the total number of all patients who underwent such an intervention. In addition, women after a hysterectomy become more susceptible to atherosclerosis and osteoporosis.
intravenous anesthesia (with tracheal intubation and absence of spontaneous breathing) and regional anesthesia (spinal and epidural anesthesia).
Intravenous anesthesia is more often used during abdominal surgery (when the uterus is removed by making an incision in the anterior abdominal wall). The advantages of such anesthesia are the patient’s deep sleep, absence of pain and good control of the patient’s condition.
For laparoscopic hysterectomy and vaginal hysterectomy, preference is given to regional anesthesia, which is performed in two ways. Carrying out spinal anesthesia causes rapid pain relief in the lower part of the patient's torso, and maximum relaxation of the abdominal muscles; with epidural anesthesia, pain relief occurs after some time, but this method allows you to treat pain after the operation has been performed. The patient is conscious during regional anesthesia, but does not feel pain.
Of course, when choosing anesthesia, they are guided by the patient’s condition, the urgency of the situation, the expected scope of the intervention and its duration. The operation time varies and can range from 40 minutes to 3 hours.
In what cases is surgery performed?
After the woman has been transported to the operating room, she is placed on the operating table and her limbs are fixed.
In the case of vaginal hysterectomy, the patient's legs are bent at the knees and hip joints (as on a gynecological chair) and spread apart. During laparotomy or laparoscopic access, the anterior abdominal wall is treated with antiseptic solutions, while the patient is under general anesthesia or regional anesthesia.
A layer-by-layer incision is made in the abdominal wall, then the situation of the organs in the pelvis is assessed (the size of the uterus, the location of nodes, the condition of the appendages; if a malignant process is suspected, the periuterine tissue and neighboring organs are examined for metastases).
The final decision on the extent of the operation is made by surgeons after opening the abdomen. The uterus and/or appendages are cut off, hemostasis is performed and the abdominal wall is sutured in layers. If necessary, the abdominal cavity is drained (risk of bleeding, peritonitis and other circumstances). If hysterectomy was planned in advance, then on the operating table the vagina is sanitized with antiseptic solutions and tamponed with a sterile napkin.
During laparoscopic removal of the uterus, after treating the anterior abdominal wall with antiseptics, 3 (on average) small incisions, 1.5–2 cm long, are made in it. Through one, a laparoscope with a microvideo camera is inserted, which feeds an image of the internal organs onto a large monitor (the operating surgeon is guided by it), and through the remaining 2, air is pumped into the abdominal cavity and special laparoscopic surgical instruments are inserted. The course of the operation in the future is no different from abdominal hysterectomy.
A vaginal hysterectomy is the removal of the uterus through the vagina. After aseptic treatment of the vagina, a speculum and a lift are inserted into it, and an incision is made in the upper third. Technically, this operation is more complex and requires a certain skill of the surgeon.
Example from practice: When I first did a supravaginal (laparotomy) amputation of the uterus, I experienced my first shock when I cut open the stomach and saw the uterus, all in nodes. I just wanted to give up everything and leave, as in the joke: “nothing works out anyway.” In principle, amputation of the uterus is a simple operation, but pitfalls lurk in the capture of the uterine arteries (they run along the ribs - the sides of the uterus, but of course they are not visible to the eye).
2 clamps are applied to the uterine arteries at the place of their intended course on each side (at a distance from each other). After which the uterus is cut off, the arterial stumps are ligated, the uterine stump is sutured with suturing of the appendages, it is peritonized and the anterior abdominal wall is sutured tightly. And so, after the uterus was cut off, blood gushed out from one side and instantly flooded the entire stomach.
This means that the artery was not intercepted. But the surgeon (very experienced) was not at a loss and blindly intercepted the pulsating vessel (it happened on his part). This was my second shock during the operation. The further course of the operation was without complications, the postoperative period was smooth. The patient was discharged with gratitude for the operation and for the fact that she did not have to go to the regional hospital.
How is the operation performed?
The duration of the procedure is no more than 1.5 hours. When the operation is performed in the morning, in the evening patients are already allowed to get up and walk a little.
The laparoscopic method does not require large incisions. 3 small punctures in the navel area are enough to carry out all the actions efficiently, and the wounds then heal quite quickly and do not lead to relapses.
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.
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. Possible complications include:
- 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.
- Carbon dioxide, which is injected into the abdominal cavity for better visualization, can cause some harm to the female body.
- The occurrence of adhesions in the pelvic area.
- In extremely rare cases, not exceeding 1% of all operations, the patient develops infectious complications.
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 relieve pain, the patient is prescribed analgesics and painkillers. 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 physical activity encouraged? 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 - still 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 consumption of spicy, fried and fatty foods. Strong tea and coffee, cocoa, alcoholic drinks, spicy pickled or canned foods, confectionery, fatty meats and fish are prohibited.
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.
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.
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.
The video talks about modern gentle methods of performing hysterectomy surgery.
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.
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.
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.
In general, patient reviews regarding laparoscopic methods for removing uterine fibroids are positive, which is explained by the minimal risk of complications, the absence of pain in the postoperative period and a short rehabilitation period, and the absence of cosmetic defects after surgery.
The laparoscopic method of treating fibroids is considered more acceptable among patients, since it is cheaper than other procedures such as FUS ablation or embolization, and the risk of relapse is minimal.
Multiple uterine fibroids or a single myomatous node larger than 12 weeks with a tendency to rapid growth, accompanied by repeated, heavy, prolonged uterine bleeding. The presence of fibroids in women over 50 years of age. Although they are not prone to malignancy, cancer develops much more often against their background.
Therefore, removal of the uterus after 50 years, according to many authors, is desirable in order to prevent the development of cancer. However, such an operation at approximately this age is almost always associated with subsequent severe psycho-emotional and vegetative-vascular disorders as a manifestation of post-hysterectomy syndrome.
Necrosis of myomatous node. Subserous nodes with a high risk of torsion on the pedicle. Submucosal nodes growing into the myometrium. Widespread polyposis and constant heavy menstruation, complicated by anemia. Endometriosis and adenomyosis grade 3-4. Cancer of the cervix, uterine body or ovary and associated radiation therapy.
Most often, the removal of the uterus and ovaries after 60 years is carried out specifically for cancer. During this age period, surgery contributes to a more pronounced development of osteoporosis and a more severe course of somatic pathology. Prolapse of the uterus of 3-4 degrees or its complete prolapse. Chronic pelvic pain that cannot be treated with other methods.
Contraindications
- lipomas;
- hemophilia;
- hemorrhagic diathesis;
- liver failure;
- gastrointestinal diseases;
- cardiovascular or respiratory pathology;
- large sizes and a large number of neoplasms located near the walls of the uterus;
- hernias;
- volumetric tumor in the appendages;
- if it is impossible to completely remove a tumor in the abdominal cavity due to the physiological characteristics of the female body.
The decision to remove the entire uterus or individual pathological tissues is made exclusively by an oncologist based on the test results obtained. Laparoscopy allows you to monitor all the surgeon’s manipulations during the operation. All indicators are displayed on the monitor, which is convenient for the doctor and effective for the patient. The method has proven in practice to be highly effective.
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;
Not every patient is allowed to undergo laparoscopic removal of fibroid tumors.
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).
Significantly pronounced subcutaneous fat;
Untreated infectious diseases;
Adhesive process;
effusion or the presence of fluid in the abdominal cavity of more than 1 liter.
But modern gynecologists, possessing the technique of laparoscopic operations, after additional examination for such diseases, prescribe a course of treatment, sanitize foci of infection and perform surgical intervention. In this case, all the pros and cons are weighed before performing laparoscopic surgery.
Procedure
Laparoscopic hysterectomy requires more than one month of recovery. With laparotomy access this period is longer.
On the first day, the woman should remain in bed. She can only get out of bed on the second day, but first she must put on compression stockings on her legs and a bandage on her stomach. These measures using stockings and a bandage are necessary for two weeks. It is recommended to get up and walk more, as this will help prevent congestion in the lungs (pneumonia) and adhesions. To prevent the former, it is recommended to inflate balloons or blow through a cocktail straw into water.
For 3-5 days after the operation, the patient is given analgesic therapy, since pain may occur during this period, and the wounds are treated with antiseptic agents. After discharge, these procedures are performed independently. Drugs and medicines are prescribed by a doctor in each case individually.
During the rehabilitation period, a woman needs to follow a diet. She should exclude white bread, coffee, sweets, chocolate and spicy foods from her diet. It is recommended to eat small portions, but 5-7 times a day. Food should be easily digestible, similar to what was used before the operation. The main goal of dietary nutrition is to prevent constipation.
After surgery, you should not lift weights exceeding 5 kg, and exercises on the abdominal muscles are prohibited. Therapeutic gymnastics is carried out only with the permission of the attending physician. Sexual activity should also be resumed after the approval of the attending physician.
The postoperative period passes with the mandatory use of hormonal medications. In addition to drug therapy and physiotherapy, a woman may be prescribed consultations with a psychotherapist.
After the operation, the woman is under the supervision of a gynecologist for 4-7 days. If complications develop, the length of hospitalization may be increased.
Minor nagging pain in the lower abdomen and spotting are common in the first time after surgery. To relieve pain, conventional painkillers (Paracetamol, Nurofen) are prescribed. However, in case of prolonged painful condition, bleeding or unnatural vaginal discharge, consultation with a gynecologist is a must.
Maintaining personal hygiene and treating surgical sutures with antiseptic solutions will prevent secondary infection with pathogenic flora. Seams can be treated with solutions of brilliant green, methylene blue, furatsilin, potassium permanganate, chlorhexidine. After being discharged home, the woman independently cares for the operated area, regularly changing the dressings.
Water procedures with taking a bath should be abandoned until the wound surface has completely healed. You can limit yourself to using a warm shower, having previously protected the damaged area with a bandage. The genital organs need complete hygiene with the use of antiseptic solutions in the postoperative period.
Compliance with a special regime in the postoperative period will speed up the recovery process. The set of necessary measures includes:
- regular consultations with a gynecologist;
- limiting physical activity and avoiding heavy lifting;
- refusal of sexual intercourse in the first 4-6 weeks after surgery;
- walking in the fresh air to prevent thrombophlebitis, congestive inflammation in the lungs, adhesions;
- use of a bandage, special shapewear, stockings in the postoperative period;
- preference for clothing made from natural materials to ensure natural ventilation;
- balanced diet with a predominance of vegetables, fruits, dairy products;
- elimination of stress factors (use of antidepressants, sedatives of synthetic and herbal origin);
- correction of hormonal levels during manifestations of menopausal syndrome.
This operation entails consequences and complications in only 1% of 100% of women undergoing surgery. What phenomena does this 1% include?
- Injury to internal organs;
- When the peritoneum is punctured, vascular damage occurs;
- Spikes;
- Infectious nature of complications;
- Special reactions to carbon dioxide.
A hysterectomy involves removing the uterus. The uterus is the organ in which the child is born. If there is no uterus, then there can be no talk of pregnancy. After the operation, the woman does not even menstruate.
If a woman dreams of having a child after such an operation, then the only way out for her may be surrogacy or adoption of a child from an orphanage.
Before the operation, you need to undergo a full examination. Only after receiving the examination results can the doctor make a decision regarding the extent of surgical intervention and the method of its implementation
The following types of examination are prescribed:
- ultrasound examination (ultrasound of the pelvic organs);
- blood test (general, biochemical, coagulability, hepatitis, blood group and rhesus, immunodeficiency, syphilis, glucose);
- urine test (general, for sugar content);
- analysis of vaginal smears;
- electrocardiogram;
- fluorography;
- colposcopy.
In some cases, an examination by other doctors, in particular a therapist or cardiologist, is also prescribed. The day before laparoscopy, it is not recommended to eat.
After surgery to remove the uterus using the laparoscopic method, the consequences in most cases will be minimal. Within a month after the operation, the woman will be able to return to her usual rhythm of life.
For the first few days after laparoscopy, a woman may feel slight nagging pain in the lower abdomen. This is considered normal and should go away in a couple of days.
In rare cases, the formation of an adhesive process is possible, as a rule, with a severe form of endometriosis or with a genetic predisposition.
There may also be some slight vaginal discharge. If the ovaries have been preserved, they continue to produce hormones, so this phenomenon is considered normal.
Inflammatory processes in the genital organs are extremely rare. This happens if a woman does not follow the doctor’s recommendations, in particular, antibacterial treatment, the course of which is the first 5 days after the operation.
To avoid unpleasant consequences, you must follow your doctor’s instructions for adjusting the water and electrolyte balance of the blood.
The positive outcome of laparoscopic hysterectomy depends on the skill of the doctor. Only in this case will the consequences of surgical intervention be minimal and the recovery period as easy as possible.
Women should not be afraid of having their uterus removed and ignore doctor’s orders. Perhaps this is the only option not only to get rid of unpleasant symptoms, but also to save lives. And the doctor will select the most suitable method of performing the operation, taking into account all factors individually in each case.
The duration of the postoperative recovery period directly depends on the woman’s age, the degree of uterine amputation, and the occurrence of any complications. The rehabilitation period begins immediately 1 day after amputation of the uterus. Of course, the stitches hurt a lot at first, so analgesics and painkillers will be prescribed. Women remain in the hospital for another 8-10 days under the supervision of the attending physician.
In the first hours you need to recover from anesthesia and sleep. It is advisable to drink water no earlier than 4 hours after the operation. At first, a catheter may be installed in the bladder to remove urine, since women need to be careful and not allow even the slightest stress on the abdominal area and the sutures that have just been applied.
Also, the stitches will be treated with antiseptics every day, 2 times a day, for the purpose of rapid healing. To normalize hormonal levels, a course of hormones, medications to regulate water and electrolyte balance, physiotherapy, and magnetic therapy may be prescribed to avoid complications in the postoperative period.
Diet is of great importance by introducing certain food restrictions into the diet, excluding foods that irritate and aggressively affect the mucous membrane of the stomach and intestines.
6 weeks after the operation, you can return to your usual lifestyle, start visiting the gym, and gradually play sports. The main thing is for women to come to terms with the idea of the absence of a uterus, to accept their new position in life and, of course, if unpleasant symptoms appear, do not neglect to see a doctor.
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.
Uterus removed
Preparing for surgery
During the period of preoperative preparation, the woman is treated for anemia, which may result from heavy menstruation. For this, the patient is prescribed iron-containing medications. With low hemoglobin, she is hospitalized and given a blood transfusion. If before removal of the uterus a woman has a large uterus, then she undergoes a monthly course of gonadotropin-releasing factor analogues.
The patient undergoes a colposcopy to identify possible erosions or other pathologies. If they are detected, then appropriate therapy is carried out, and surgery is planned in a month.
1-2 weeks before removal of the uterus, a woman is prescribed tests and studies:
- 1. Swabs from the vaginal cervix using the PCR method. They are needed to check for the presence of cancer cells, chlamydia, herpes group viruses, toxoplasma and ureplasma.
- 2. Blood clotting test.
- 3. General blood and urine analysis.
- 4. Biochemical blood test for glucose and other indicators.
- 5. Analysis for blood group and Rh factor.
- 6. Fluorography.
- 7. ECG.
- 8. Test for hepatitis, HIV, syphilis.
Preparations for the operation are also carried out in the hospital where it will be performed. Therefore, the woman is hospitalized at least 24 hours in advance. Moreover, surgical intervention should be carried out during the period from the end of menstruation to ovulation. The day before surgery, a woman needs to switch to easily digestible foods - fermented milk products, cereals, purees, soups.
The night before surgery and the next morning, the woman is given an injection to reduce anxiety and fear. Since the operation is performed under general anesthesia, the last time you eat is before 18:00 on the evening before the procedure, and you stop drinking 6-8 hours before the operation itself. At the appointed time, the woman must put on special compression stockings.
The preparatory period before surgery includes a protective regime for 7-14 days. The main preparatory activities include:
- restriction of sexual activity (use of barrier methods of contraception);
- correction of hematopoietic function (use of iron-containing drugs to eliminate anemia, as well as drugs that affect blood viscosity);
- a course of treatment with gonadotropin-releasing factor drugs to correct the functioning of the ovaries;
- colposcopy with biopsy and subsequent histological examination of the tissue fragment;
- cytological examination of a smear from the vagina and cervical canal for pathogenic flora, including sexually transmitted diseases;
- blood tests (including coagulation test, biochemical blood test);
- chest fluorography;
- electrocardiogram followed by consultation with a therapist;
- ultrasound examination of the pelvic area;
- diet correction - switching to easily digestible foods (porridge, vegetables, lactic acid products);
- preparation of the intimate area (shaving the hair);
- preparation of special shapewear, stockings, bandages.
First of all, the woman will be asked to undergo tests to assess her general condition, as well as the degree of pathological processes in the uterus. Perhaps, during the preparatory period, the doctor will prescribe a course of drug therapy to keep the body and individual organs normal, for example, in case of problems with the heart, blood vessels, or the occurrence of inflammatory processes in the patient.
Before the operation, patients are prescribed a general blood test for HIV, hepatitis C, as well as fluorography, biochemistry, and a smear from the cervical canal into the vagina to determine the absence (presence) of malignant cells. The main thing for the doctor is to make sure that there are no contraindications for the laparoscopic method.
In addition, the blood type of women should be established in case of sudden transfusion due to the formation of a blood clot. The patient's general well-being and condition are checked, pulse, blood pressure, and temperature are measured. It is possible to prescribe medications before laparoscopy to regulate the functions of all vital organs and decrease (increase) blood clotting if necessary.
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.
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 through epidural anesthesia or general anesthesia. Then punctures are made in the peritoneum necessary to insert instruments. Carbon dioxide gas is released into the retroperitoneal cavity, which expands the abdominal walls, which provides more space for surgical manipulations.
The laparoscopic operation lasts no more than 2 hours, and within a few hours after the intervention the patient is allowed to walk.
The preparatory period for planned surgical intervention consists of conducting possible examinations at the prehospital stage - clinical and biochemical blood tests, urine tests, coagulogram, determination of blood group and Rh factor, studies for the presence of antibodies to hepatitis viruses and sexually transmitted infectious agents, including including syphilis and HIV infection, ultrasound, chest fluorography and ECG, bacteriological and cytological examination of smears from the genital tract, extended colposcopy.
In the hospital, if necessary, additional hysteroscopy is performed with separate diagnostic curettage of the cervix and uterine cavity, repeated ultrasound, MRI, sigmoidoscopy and other studies.
1-2 weeks before surgery, if there is a risk of complications in the form of thrombosis and thromboebolism (varicose veins, pulmonary and cardiovascular diseases, excess body weight, etc.), a consultation with specialized specialists and the use of appropriate medications, as well as rheological agents and antiplatelet agents.
In addition, in order to prevent or reduce the severity of symptoms of post-hysterectomy syndrome, which develops after removal of the uterus in an average of 90% of women under 60 years of age (mostly) and has varying degrees of severity, surgical intervention is planned for the first phase of the menstrual cycle (if any) .
1-2 weeks before the removal of the uterus, psychotherapeutic procedures are carried out in the form of 5-6 conversations with a psychotherapist or psychologist, aimed at reducing the feeling of uncertainty, the unknown and fear of the operation and its consequences. Phytotherapeutic, homeopathic and other sedatives are prescribed, concomitant gynecological pathology is treated, and cessation of smoking and drinking alcoholic beverages is recommended.
These measures can significantly ease the course of the postoperative period and reduce the severity of psychosomatic and vegetative manifestations of menopausal syndrome provoked by the operation.
In the hospital on the evening before the operation, food should be excluded, only liquids are allowed - loosely brewed tea and still water. In the evening, a laxative and a cleansing enema are prescribed, and a sedative is taken before bedtime. On the morning of the operation, the intake of any liquid is prohibited, the ingestion of any medications is discontinued, and the cleansing enema is repeated.
Before the operation, compression tights and stockings are put on, or the lower extremities are bandaged with elastic bandages, which remain until the woman is fully activated after the operation. This is necessary in order to improve the outflow of venous blood from the veins of the lower extremities and prevent thrombophlebitis and thromboembolism.
Providing adequate anesthesia during surgery is also important. The choice of the type of anesthesia is carried out by the anesthesiologist, depending on the expected volume of the operation, its duration, concomitant diseases, the possibility of bleeding, etc., as well as in agreement with the operating surgeon and taking into account the wishes of the patient.
Anesthesia for hysterectomy can be general endotracheal combined with the use of muscle relaxants, as well as its combination (at the discretion of the anesthesiologist) with epidural analgesia. In addition, it is possible to use epidural anesthesia (without general anesthesia) in combination with intravenous drug sedation.
A consultation with an anesthesiologist is mandatory, who will identify and prevent the occurrence of allergic reactions to the drugs used for amputation. Before the operation, exactly one day before, the patient needs to cleanse the intestines with an enema. In addition, the woman must follow a special diet for some time.
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.
How long should you not lift weights after hysterectomy?
After laparoscopic removal of the uterus, the patient may experience certain complications. Postoperative negative consequences include:
- bleeding from the vagina;
- hormonal imbalances;
- depression.
Just like abdominal and vaginal hysterectomy, laparoscopic hysterectomy compromises tissue integrity. Blood vessels may be damaged as a result of the operation. For this reason, bloody vaginal discharge may appear almost immediately after surgery. Impaired hemostasis is a rather life-threatening condition for health and life, therefore, if a clinical sign occurs at home, you should immediately consult a doctor.
Hormonal imbalances after surgery can manifest as symptoms of menopause. A woman may experience so-called hot flashes, which are accompanied by a feeling of heat in the chest and face, weakness, lack of air, decreased performance and increased irritability. If these clinical signs occur, you should consult a gynecologist to receive appropriate hormone replacement therapy. Taking hormonal medications should help the woman improve her condition and return to her normal life.
Depressive conditions often appear after removal of the uterus with all appendages. They can develop against the background of hormonal imbalances or without them. The likely cause of depression in a woman under 40-45 years of age is a feeling of inferiority after removal of a reproductive organ.
All these complications are manageable. All you need to do for this is to promptly seek help from a gynecologist.
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.
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.
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.
Even with such a safe removal of fibroids as laparoscopy, there is a possibility of postoperative complications.
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.
In addition to intestinal functionality, the principles of 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.
In addition, due to hormonal disorders, not only does libido decrease, but many women (every 4 to 6 women) develop atrophy processes in the vaginal mucosa, which leads to dryness and urogenital disorders. This also adversely affects sex life.
What medications should be taken to reduce the severity of negative consequences and improve the quality of life?
Considering the staged nature of the disorders, it is advisable to use sedatives, antipsychotic drugs, and antidepressants in the first six months. In the future, their use should be continued, but in intermittent courses.
For preventive purposes, they should be prescribed during the most likely periods of the year for exacerbations of the pathological process - in autumn and spring. In addition, in order to prevent the manifestations of early menopause or reduce the severity of post-hysterectomy syndrome, in many cases, especially after ovarian hysterectomy, it is necessary to use hormone replacement therapy.
All drugs, their dosages and duration of treatment courses should be determined only by a doctor of the appropriate profile (gynecologist, psychotherapist, therapist) or together with other specialists.
Removal of the uterus is a very serious operation that should only be performed in special cases. For women's health, such a surgical intervention can lead to quite unpleasant consequences, but it is not always possible to avoid removal of the uterus. In some cases, this is the only opportunity to save the life and health of the patient.
prolapse and prolapse of the uterus; oncology; thickening of the uterine walls; myoma; endometriosis; fibroma; metastases; a large number of polyps; infection during childbirth; regular bleeding and severe pain that is not associated with the menstrual cycle.
Most often, such an operation is performed on women after 40-50 years of age, but it can also be prescribed to patients under 40, but only in cases where other treatment methods are powerless and the health, and sometimes the life of the patient, is in danger.
tumors with metastases, adhesions, endometriosis, ovarian and uterine cancer.
The recovery period after this method is very difficult and long. During this time, the lower abdomen must be supported with a bandage, which will help reduce pain and speed up healing.
Laparoscopic method. The operation is performed using small incisions in the lower abdomen, then, using a laparoscope, the uterus is cut into several parts, which are removed using a tube.
This operation has a short rehabilitation period, and a woman, both at a young age and over 40 and 50 years old, recovers quite quickly and experiences virtually no pain. It is worth knowing that this type of amputation has a high cost.
Vaginal method. It involves access through the natural reproductive tract, through which the uterus is amputated, without incisions in the lower abdomen. This type of operation is relevant for organ prolapse or if the uterus is small.
After such a surgical intervention, there are no abdominal scars or scars left on the woman’s body, since the entire procedure takes place through the vagina. The pain is not very intense. Rehabilitation is fast and has almost no complications.
the muscles of the anus are weakened, which affects the act of defecation; there is periodic pain in the chest area; if the scar does not heal well, adhesions may form; there is pain in the lower abdomen; the ovaries are poorly supplied with blood; blood clots and swelling of the legs appear; urinary incontinence occurs; tides are observed;
pain occurs in the lumbar region; have intestinal problems; there are problems with urine output; excess weight may appear; vaginal dryness occurs; vaginal prolapse is observed; the general health of the pelvic organs deteriorates; after surgery, in some cases, bleeding occurs; the lymph nodes become inflamed, which causes an increase in temperature.
An operation under general anesthesia can cause nausea and vomiting in the first hours after the process, and a little later – frequent hot flashes. Staying in bed for a long time after surgery is not recommended.
After amputation of the uterus, the patient may experience severe pain, this is normal, as the healing process occurs. The pain is felt both externally, in the area of the suture, and internally, covering the lower abdominal cavity.
During this period, doctors prescribe painkillers (Ketonal, Ibuprofen).
supravaginal hysterectomy – up to 1.5 months; vaginal hysterectomy – up to a month; laparoscopic hysterectomy – up to a month.
the appearance of hemorrhoids; constipation; difficulty going to the toilet; pain in the lower abdomen.
Hemorrhoids appear due to the fact that the intestines are displaced under pressure on the lower abdomen of other organs, and part of it begins to fall out. Hemorrhoids bring a lot of unpleasant sensations and cause great discomfort.
Uterus removed
Price
Prices for laparoscopic hysterectomy depend on the clinic and the city in which the operations are performed. Below are three centers that perform such operations.
Indeed, removal of the uterus using laparoscopy is more expensive than other methods. But the patient overpays for the fact that the method will cause minimal consequences and complications.
So, if your doctor has ordered a hysterectomy, it would be wise to have it done by laparoscopy. This method has proven itself well and has only positive reviews.
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.
How much does a hysterectomy cost? The price of a hysterectomy depends on several factors: the level of the hospital, the skill of the surgeon, the extent of the operation, the region and the length of hospital stay. The cost of the operation is also affected by the method of surgical intervention. In private clinics in Moscow, laparoscopy will cost from 16 to 90 thousand rubles.
An important question: “Operation to remove the uterus: how much does it cost” also faces a woman. It is difficult to give a definite cost for the operation.
Firstly, it is determined by the region in which the future patient lives, the level of equipment of the hospital, the qualifications of the doctor, the suture material used during the operation, the volume of intervention and the conditions of stay in the postoperative period. Secondly, the price depends on the surgical approach and type of operation.
For example, embolization of the uterine arteries costs about 100,000 rubles, Laparoscopic extirpation or amputation of the uterus from 16,000 to 90,000, removal of the uterus via the vaginal route ranges from 20,000 to 80,000 rubles. Hysterectomy performed through laparotomy should be free in the hospital at the place of registration or in the regional center, but private clinics carry out such interventions for money. The price ranges from 9,000 to 70,000 rubles.
Application in gynecology
1. Ectopic pregnancy.
2. Pipe rupture.
3. Surgical sterilization.
4. Endometriosis.
5. Adhesive disease.
6. Various ovarian diseases: cysts, sclerocystosis, ovarian apoplexy.
7. Benign formations of the uterus (removal of the uterus using the laparoscopic method reduces the risk of postoperative complications).
8. Hyperplastic processes that are not amenable to conservative therapy.
Recently, gynecologists have widely used laparoscopic hysterectomy, even for malignant tumors. Now many techniques have been developed for this operation, depending on the size of the uterus, its condition and the involvement of neighboring organs in the process. This operation is widely used for fibroids of various locations.
Operation technique
Preference is given to laparoscopic or assisted vaginal subtotal or total hysterectomy with preservation of the appendages on at least one side (if possible), which, among other advantages, helps reduce the severity of posthysterectomy syndrome.
Surgical intervention with a combined approach consists of 3 stages - two laparoscopic and vaginal.
introduction into the abdominal cavity (after gas insufflation into it) through small incisions of manipulators and a laparoscope containing a lighting system and a video camera; performing laparoscopic diagnostics; separation of existing adhesions and isolation of the ureters, if necessary; application of ligatures and intersection of round uterine ligaments;
dissection of the anterior vaginal wall; intersection of the vesicouterine ligaments after displacement of the bladder; making an incision in the mucous membrane of the posterior vaginal wall and applying hemostatic sutures to it and to the peritoneum; applying ligatures to the uterosacral and cardinal ligaments, as well as to the vessels of the uterus, with subsequent intersection of these structures;
At the third stage, laparoscopic control is performed again, during which small bleeding vessels (if any) are ligated and the pelvic cavity is drained.
How long does hysterectomy surgery take?
This depends on the method of access, the type of hysterectomy and the extent of surgery, the presence of adhesions, the size of the uterus and many other factors. But the average duration of the entire operation is usually 1-3 hours.
The main technical principles for removing the uterus using laparotomy and laparoscopic approaches are the same. The main difference is that in the first case, the uterus with or without appendages is removed through an incision in the abdominal wall, and in the second, the uterus is divided into fragments in the abdominal cavity using an electromechanical instrument (morcellator), which are then removed through a laparoscopic tube (tube ).
Surgery to remove the uterus using the laparoscopic method is performed for fibroids up to 16 weeks of pregnancy, which are complicated by bleeding, characterized by rapid growth or the risk of malignant degeneration. Although some experienced specialists completely remove the uterus, the size of which is about 20 weeks.
Three or four punctures are used in the abdominal wall (one near the navel, the other two on the sides) and trocars are inserted. This is a device equipped with a monitoring camera or light installation with a carbon dioxide or nitrous oxide blower and tools.
After examination, uterine fibroids are removed laparoscopically. To do this, the ligaments are excised, the vessels are ligated, the uterus is cut off from the vaginal walls and removed through the vagina through incisions in the fornix. This operation is called laparoscopically assisted vaginal myomectomy. The incisions in the vagina are sutured. In one operation, it is possible to remove several nodes without repeated intervention.
At the end, the blood or fluid that accumulated during the operation is removed, and the organs and walls of the abdominal cavity are examined again. Carefully check whether the vessels are well ligated and ligated, and whether there is any leakage of blood or lymph fluid. Eliminate the gas and remove the instruments. Then sutures are placed on the skin and subcutaneous tissue at the sites where the trocars are inserted, and the skin is sutured with cosmetic sutures.
The duration of the operation can be from 15 minutes to 1.5 hours, depending on the volume of surgery performed.
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 for surgical removal of 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 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. Possible complications include:
- 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.
- Carbon dioxide, which is injected into the abdominal cavity for better visualization, can cause some harm to the female body.
- 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 relieve pain, the patient is prescribed analgesics and painkillers. 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 physical activity encouraged? 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 - still 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 consumption of spicy, fried and fatty foods. Strong tea and coffee, cocoa, alcoholic drinks, spicy pickled or canned foods, confectionery, fatty meats and fish are prohibited.