How is the operation to remove the uterus in women performed in gynecology? Gynecological operation laparoscopy of the uterus How is the operation to remove the uterus performed using a laparoscope
Every year, low-traumatic surgical interventions are used more and more often. One of them is removal of the uterus using the laparoscopic method. Performing a laparotomy during extirpation of the uterus and appendages implies serious damage to healthy surrounding tissues. That is why the laparoscopic version of this operation is becoming increasingly popular, both among doctors and patients.
Main indications
Removing the uterus using the laparoscopic method is a fairly serious surgical procedure. To carry it out, the patient must have clear indications. Among them:
- malignant neoplasms;
- the presence of multiple benign tumors of the uterus in combination with pathology of its cervix;
- adenomyosis;
- widespread external endometriosis in combination with pathology of the endometrium and uterus;
- atypical and recurrent hyperplasia, as well as endometrial polyposis.
All these diseases can cause dangerous complications. That is why, if they are present, in no case should you refuse to perform laparotomy. Extirpation of the uterus and appendages in this case will save the woman’s life.
About contraindications
Laparoscopic hysterectomy, like all other surgical interventions, has a number of contraindications. The main ones among them are the following:
- severe general condition of the patient;
- presence of decompensated chronic diseases;
- the presence of acute infectious diseases;
- uterine prolapse;
- large size of the uterus;
- adhesions in the pelvis;
- the presence of free fluid with a volume of more than 1 liter in the pelvic cavity;
- the presence of large cystic formations on the organs being removed.
Most of these contraindications are relative. They can be eliminated with conservative treatment. Prolapse of female genital organs is included in this list for the reason that with this pathology it is much easier to perform an operation such as vaginal hysterectomy.
Another contraindication for laparoscopic intervention is the large size of the uterus (more than 16 weeks of pregnancy) and the presence of large cystic formations on it and its appendages.
Preparing for surgery
Laparoscopy is a method that allows you to remove the uterus and any of its appendages within 1 hour in the absence of aggravating factors. Moreover, preparation for this intervention will be as extensive as for conventional abdominal surgery. It includes the following elements:
- Taking tests.
- General blood analysis.
- Blood chemistry.
- Blood test for glucose levels.
- Coagulogram.
- Analysis to determine blood group.
- Analysis to determine the Rh factor of blood.
- General urine analysis.
- Passing an instrumental examination.
- Ultrasound of the pelvic organs.
- Colposcopy.
- Electrocardiography.
- Diagnostic curettage with biopsy (for tumor diseases).
- Examination by specialists.
- Gynecologist.
- Therapist.
- Oncologist (for tumor diseases).
- Any other specialist in the presence of concomitant pathology.
- Preoperative preparation.
- Lack of food for 1 day.
- Pubic hair removal.
- Colon cleansing with an enema.
- Filling out consent for surgical intervention.
- Medication preparation.
All these measures significantly reduce the risks when performing such a serious surgical intervention as laparoscopic hysterectomy.
Progress of surgery
Removal of the uterus can be performed in the following 3 ways:
- laparoscopic;
- abdominal;
- vaginal.
Abdominal surgery involves laparotomy. As a result of such intervention, serious damage to surrounding tissue occurs. Vaginal surgery is less traumatic, and its duration is much shorter than that of abdominal surgery. At the same time, vaginal hysterectomy may not be performed very often due to the presence of a large number of contraindications. It is the first method that is the most gentle. The course of laparoscopic extirpation of the uterus with all appendages includes several stages:
- Several (usually 3) incisions ranging in size from 0.5 to 1.5 cm are made in the lower abdomen.
- Penetration of the laparoscope into the patient's abdominal cavity. This device is a dynamic device with a video camera attached to the end.
- Inspection of organs subject to surgical intervention using a laparoscope, assessment of their relative position, as well as identification of possible factors aggravating the removal.
- Abduction of the uterus anteriorly and to the right.
- Cutting and coagulation of the left round ligament.
- The peritoneum is opened in the transverse direction.
- The continuation of the vesico-cervical ligament is separated, which leads to exposure of the space between the anterior vaginal fornix and the bladder.
- Coagulation and intersection of lateral seals (the so-called “legs” of the bladder).
- Abduction of the uterus anteriorly and to the left.
- Carrying out manipulations similar to stages 5-8, but from the other side.
- Opening the posterior layer of the broad uterine ligament.
- The fallopian tube is coagulated and crossed, as well as the ovarian ligament (in cases where the uterine appendages are preserved during the operation). If laparoscopic hysterectomy is performed along with uterine appendages, then in this case this stage is replaced by coagulation followed by intersection of the infundibulopelvic ligament.
- Giving the uterus a vertical position and moving it to the side.
- Pulling down the posterior layer of the peritoneum.
- Coagulation and cutting of the uterosacral ligaments, as well as the peritoneum located between them.
- Stitching or coagulation of the vascular bundle.
- Transection of the vascular bundle.
- The uterus is cut off simultaneously with coagulation of all bleeding vessels of the vaginal walls.
- Removal of the uterus. More often it is carried out through the vagina. If the uterus is too large, then it is divided into several parts using an electric knife.
- Suturing the vaginal stump.
- Hemostasis control.
There is a more gentle operation - laparoscopic subtotal hysterectomy. It is perfect when you can save the cervix. This type of surgery is less traumatic, but its use is limited.
Postoperative period
After a laparoscopic hysterectomy is performed, the postoperative period can last up to 12 weeks. This is significantly less than after an operation such as abdominal or vaginal hysterectomy. The relative short duration of the recovery period after laparoscopy is due to the fact that during such an intervention a relatively small amount of healthy tissue is injured.
The main symptom that will bother the patient for a long time after such an intervention is pain in the lower abdomen. In the first days after surgery, it is very pronounced, and therefore doctors prescribe the patient to take narcotic analgesics. After this, the patient has to take regular painkillers for 1.5-2 weeks. Unexpressed pulling pains in the lower abdomen may bother the patient for 6-9 weeks.
Another characteristic symptom after laparoscopic removal of the uterine organ complex is general weakness and decreased ability to work. Usually they bother the patient for no more than 6 weeks.
Possible complications
After laparoscopic removal of the uterus, a woman may experience certain complications. The main ones among them are the following:
- Hormonal disorders.
- Bloody vaginal discharge.
- Depression.
Hormonal disorders manifest themselves as symptoms of menopause. The woman feels so-called “hot flashes”. They are accompanied by a feeling of heat in the face and chest, lack of air, weakness, decreased ability to work, and increased irritability. If laparoscopic hysterectomy causes such symptoms, you should consult a gynecologist. He will help the woman choose suitable hormonal drugs for replacement therapy. After starting to take such medications, the patient will feel much better and will be able to return to a full life.
Laparoscopic surgery, like abdominal and vaginal hysterectomy, leads to disruption of the integrity of body tissues and damage to a large number of blood vessels. After surgery, bloody vaginal discharge may appear. This usually indicates a violation of hemostasis and is a rather ominous symptom. In this case, the woman should immediately consult a gynecologist. He will examine her and prescribe an ultrasound examination of the pelvic organs. Once the cause is determined, the necessary treatment will be prescribed.
Depression is a common complication after removal of the uterus and all appendages. It can develop both against the background of hormonal disorders and without them. Also, a woman’s depressive disorder due to such an operation occurs due to the fact that she begins to feel inferior.
Any complications other than infertility after laparoscopic hysterectomy can be eliminated. To do this, you should consult a gynecologist in a timely manner.
Main advantages
Laparoscopic surgical techniques have certain advantages:
- Low morbidity.
- Virtually no cosmetic defects.
- High speed of surgical interventions.
- There is a high probability of admission to surgery for patients with serious chronic pathologies of the cardiovascular and respiratory systems.
- Relatively short postoperative period.
- Relatively few postoperative complications.
Thanks to these advantages, laparoscopic surgeries are becoming increasingly common.
Laparoscopy is the most gentle method of surgical intervention in gynecology, which does not require making incisions in the abdominal cavity. Its main advantage is the minimal number of unpleasant consequences and complications. This method is used for the treatment and diagnosis of many gynecological diseases.
Laparoscopy of the uterus is one of the modern minimally invasive methods of surgical intervention, during which only a few punctures will need to be made in the abdominal area.
The laparoscopic method of surgery does not leave marks or scars on the skin of the abdomen, and also minimizes the risks of developing thromboembolism and pneumonia.
Laparoscopy of the uterus is used to treat and diagnose various diseases. With its help, you can identify endometriosis, fibroids, cysts and identify the cause of infertility. Full recovery after such an operation will require no more than two weeks.
What is uterine laparoscopy?
This method causes less harm to the body and has virtually no complications.
There are two types of laparoscopy:
- diagnostic – it is used to confirm or refute a diagnosis.
- surgical – used for the treatment of female genital organs.
If the disease is in its early stages, this method helps to completely remove the tumor. Even at an advanced stage, laparoscopy allows you to save the uterus and remove only the tumor present in it. This method helps maintain the menstrual cycle and also gives a woman the opportunity to become a mother.
Features of uterine laparoscopy
This technique has gained great popularity in gynecology, and all because:
- It does not require an incision.
- Prevents the development of adhesions in tissues due to low risk of injury.
- Helps to examine the abdominal cavity in detail.
- It is possible to increase it several times.
- Short rehabilitation period.
- Leaves no marks or scars.
In what cases is laparoscopy performed?
As noted above, laparoscopy has different purposes; some require it to accurately diagnose a disease, while others need it to treat it. It may also be prescribed after surgery to monitor the healing process. But the most common purposes of laparoscopy are:
When is laparoscopy performed?
Preparation for the operation begins with finding out the patient’s menstrual cycle. This question is very important, because the effect of the procedure depends on it. If you do it during menstruation, you can get an infection, because the female body is most susceptible to various types of infections at this time.
According to gynecologists, laparoscopy is best done immediately after menstruation, or in the middle of the cycle. If this method is required to treat infertility, then it is better to do it after ovulation, so you can see what happens to the egg.
A method such as laparoscopy is used to treat ovarian and uterine cysts. To do this, three punctures are made in the abdominal cavity without cutting the abdominal muscles. The main advantages of this method are:
- Minimal risk of developing adhesions.
- There is a low likelihood of a hernia occurring after surgery, which usually occurs due to incompetence of the cut muscles.
- There are no major incisions, which allows for a quick recovery.
- Reducing the risk of intestinal hypotension, as well as the development of other diseases of nearby organs.
This method allows you to return to normal life much faster and forget about the disease.
What complications can there be?
After ovarian laparoscopy, most often you experience severe pain not only in the place where the operation was performed, but also in the area of the right side and shoulder. The reason for this is the accumulation of carbon dioxide residues in the liver, which acts on the nerve as an irritant. Muscle pain and swelling of the limbs may also occur.
In the first days after the procedure, gases may accumulate in the upper fat layer. This is not life-threatening and goes away within a few days.
They may also appear, but after laparoscopy this happens very rarely.
Complications such as:
- Damage to internal organs, which can occur both during the penetration of the instrument and during the process of filling the abdominal cavity with carbon dioxide.
- Damage to blood vessels during the puncture process. This can lead to severe bleeding and blood transfusions.
- Infection that can penetrate the wound. It is to prevent such consequences that after surgery it is necessary to take a course of antibiotics.
In any case, after the operation, an individual rehabilitation course is selected for the woman and her nutrition is regulated (refusal of fatty, sweet, starchy, spicy, etc.).
When is laparoscopy not performed?
Laparoscopy cannot be performed if:
- severe obesity;
- existing chronic diseases, as well as the risk of stroke or heart attack;
- blood clotting pathologies;
- recent abdominal surgery, within six months;
- suspicion of a malignant tumor;
- accumulation of blood in the abdominal cavity;
- fistulas and purulent lesions of the abdominal cavity.
How long does the operation take?
No doctor can give an exact answer to the question about the duration of this method. Everything here is individual and depends on many factors. On average, the operation takes from half an hour to 3 hours. During this time, the surgeon carries out a number of activities:
- Introduction of anesthesia.
- Performing punctures, usually 3 or 4.
- Filling the abdominal cavity with carbon dioxide. This is necessary to protect internal organs from injury and create space for the surgeon to work.
- The insertion of the laparoscope is a small tube with a mini camera. This helps the doctor monitor what is happening inside.
- If necessary, additional tools can be used. For example, during ovarian laparoscopy you will also need scissors, forceps and a coagulator.
- Removing the laparoscope and removing gas.
- Stitching.
Important! On average, after 2 hours the patient will be able to move independently. This point is mandatory; it helps prevent the development of adhesions.
How is laparoscopy performed to remove the uterus?
Laparoscopy to remove the uterus is an excellent alternative to hysterectomy, which is performed in the case of a malignant tumor. First, a woman must undergo a full course of examination. Only after this can a laparoscopy to remove the uterus be prescribed. The examination consists of:
Based on the patient’s condition, other types of examination may be prescribed.
Laparoscopy to remove the uterus
Typically, uterine laparoscopy is performed for existing fibroids, which grow very quickly and are accompanied by pain. In this case, the doctor, based on the examination, decides whether to remove the tumor itself or the uterus itself. If you have to resort to the second option, then the procedure is as follows:
- Four punctures are made and trocars with a special chamber are inserted. This allows you to see and control what is happening inside. This device also has a light installation.
- After the examination, the surgeon alloys (i.e. places ligatures on them to prevent bleeding) the vessels and cuts off the uterus from the vaginal walls.
- The uterus is then removed through the vagina and the incisions are sutured.
Important! This operation also makes it possible to remove lymph nodes.
- If a large amount of blood has accumulated during laparoscopy, it is also removed.
- The surgeon examines the abdominal cavity.
- Sutures are applied to the puncture sites.
Anesthesia is an integral part of the laparoscopic method. This issue is resolved individually by the doctor and anesthesiologist. At the same time, the patient’s condition is assessed, the examination results are reviewed, and, based on this, the issue of anesthesia is decided. Endotracheal anesthesia is most often prescribed; it eliminates headaches after surgery. After the procedure, the woman wakes up within 15 minutes.
Carrying out laparoscopy to remove an ovarian cyst for endometriosis
Endometriosis is a disease in which cells of the walls of the uterus grow outside of it (on the fallopian tubes, peritoneum, appendages, etc.), including on cysts. This disease requires mandatory removal of the tumor, as it very quickly becomes large. In this case, laparoscopy is the most optimal and safe option, thanks to which you can completely recover from this disease.
Before starting the operation, you need to decide on anesthesia. This is decided by the anesthesiologist and the anesthesia is different for each case. After that:
- The patient is given a sleeping pill and a sedative.
- A puncture is made in the abdominal cavity and carbon dioxide is injected inside.
- Then two more punctures are made and a laparoscope with a video camera is inserted.
- The surgeon examines the abdominal cavity and clarifies the diagnosis. After this, the question of the method of surgical intervention is decided. If the tumor is malignant, then you will have to resort to more radical methods.
- Next, the cyst is enucleated and part of the ovary is removed.
- After this, the doctor examines the abdominal cavity again and removes the devices.
- The operation is completed, stitches are placed on the puncture sites.
Recovery process
For several days after the procedure, the woman may experience pain in the abdominal area. This is a normal phenomenon that goes away after a couple of days. If you experience severe nausea during the recovery period, it is better to consult a doctor..
The first days after laparoscopy you need to drink water, and, preferably, do this in a supine position. Already on the second day, you can start eating light snacks so as not to put too much strain on your stomach. These can be broths, cottage cheese, oatmeal. Usually sick leave is given for a month, but physical work is prohibited for two months.
Two weeks after the operation, the patient already feels normal, but there is no need to overload the abdominal muscles. Sometimes women develop adhesions, this happens due to a genetic predisposition or endometriosis. Disturbing discharge is a normal process, which means the ovaries produce hormones.
Various types of inflammation occur very rarely, since antibiotics are indicated after surgery. All medications recommended by a doctor should be taken in the prescribed manner, otherwise it will lead to adverse consequences (inflammation, infections, etc.).
Any disease of the female genital organs requires a complete examination and treatment. If pathologies requiring surgical intervention are identified, it is best to resort to laparoscopy. Thanks to it, it is possible to perform the operation without severe damage to the abdominal area.
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Last updated April 20th, 2019 at 08:58 pm
Among gynecological diseases, there are particularly complex pathologies that cannot be cured without surgical methods. The most serious operation is hysterectomy - removal of the uterus when diagnosing disorders that threaten a woman’s life. The laparoscopic method is recognized as the most minimally traumatic option for surgical intervention in modern medicine, allowing to protect the patient from dangerous complications after traditional abdominal surgery.
Laparoscopic surgery, which medicine became familiar with more than 20 years ago, is successfully used in gynecology. In the past, laparoscopy was used for minor gynecological surgeries. Today, in the field of gynecology, many clinics use the laparoscopic method due to its low invasiveness. Removal of the female reproductive organ (uterus) is carried out through small incisions in the abdominal cavity without the threat of large blood loss.
Important video about how to avoid hysterectomy.
The sad consequence of hysterectomy is the inability to conceive and bear a fetus. An important advantage of resection is the elimination of the threat to a woman when diagnosed with fibroids or endometriosis with the prescription of hormone replacement therapy.
When can amputation be prescribed?
In a woman's body, the uterus provides the function of procreation. Externally, the organ looks like a small sac with elastic walls, which is necessary for bearing a growing fetus. The following pathological deviations may be prerequisites for choosing the laparoscopic method:
- proliferation of muscle tissue of a benign or malignant nature;
- problems with conceiving or bearing a fetus due to endometriosis;
- pathologies associated with prolapse or prolapse of the uterine body;
- the presence of multiple nodular formations of small or large size;
- violation of the integrity of the uterus during pregnancy, as well as labor;
- development of acute inflammation of nearby organs.
If the gynecologist has prescribed laparoscopic removal of a tumor on the uterus, do not be alarmed. The ability to broadcast the progress of the operation on the monitor facilitates the safe disposal of even large tumors. Preserving an organ thanks to laparoscopy does not deprive a woman of the happiness of motherhood.
Types of surgical methods
Regardless of the type of uterine tumor, the laparoscopic method is the most minimally invasive type of surgery, which allows you to fully preserve the function of the reproductive organ.
Resection of an organ important for a woman is prescribed when conservative forms of treatment are powerless, as well as in the event of an alleged threat to the patient’s life. Based on the type of access to the object and the method of implementing surgical measures, a certain type of surgery is chosen to remove the uterus.
- Using the laparoscopic method, organ-saving surgery is performed with the possibility of visual control of the surgeon’s actions. The surgeon gains access to the organ through small incisions in the peritoneum.
- Laparotomy surgery is considered more reliable, but patients find it difficult to tolerate the peculiarities of the postoperative period. Resection involves making a large incision in the abdominal cavity.
- Due to the lack of visibility, the extirpation technique is often supplemented with laparoscopic intervention. Hysterectomy is performed using vaginal access in case of a global pathological process.
Diagnostic laparoscopy.
Due to the versatility of laparoscopy, it can be used not only for resection of the reproductive organ, but also for diagnostics. Using special manipulators, the doctor gains access to internal organs to assess their condition.
Laparoscopic removal method
Surgical intervention is carried out in the most modern way under anesthesia (local or general) in a hospital setting. The manipulation is preceded by a special training program for the patient. Removal of fibroids in the uterus using the laparoscopic method.
Stages of preparation and performance of surgery using the laparoscopic method
- During the preparatory period (2 weeks), the patient undergoes an examination to obtain the results of laboratory tests and examination by specialists. A few days before the intervention, foods that disrupt digestion are excluded from the diet. On the day of the hysterectomy, a cleansing enema is indicated.
- After anesthesia, the surgeon makes 3-4 small punctures on the surface of the patient’s abdomen. Through one of them, the abdominal cavity is filled with harmless gas to expand the peritoneal space. The remaining incisions are used to insert instruments - lighting devices, manipulators, a laparoscope with a miniature video camera.
- The doctor watches the necessary surgical procedures on the monitor screen. The possibility of visual control provides a detailed overview of the condition of the uterine pharynx and determines the degree of tissue damage. The process of removing the uterus or a tumor on it takes place without damaging neighboring organs.
- During the operation, the surgeon easily removes small fibromatous nodes using the laparoscopic method. Large units are first crushed and then evacuated using a special device. In case of removal of a large uterus, it is cut into several parts for safe removal from the peritoneum.
- After forced amputation, the surgeon must ensure that the vessels are ligated securely and that there is no bleeding. The abdominal cavity is freed from instruments, blood residues, and expanding gas. After examining the walls of the peritoneum, the doctor applies an anti-adhesion mesh to prevent the appearance of a postoperative scar.
- At the final stage of the intervention, using the laparoscopic method, the edges of the abdominal incisions are connected with intradermal sutures. The application of cosmetic sutures, which dissolve after 3 months, does not result in aesthetic problems for the patient.
Based on the volume of surgical procedures performed, the duration of the operation is 20 minutes or about an hour. In case of complications, the procedure can last several hours. Upon discharge from the hospital, the patient receives a disc with a record of the progress of laparoscopy.
Chronology of the postoperative period
Rehabilitation after resection of the organ necessary for conception does not require a long time; the duration of the stage is on average one month. The duration of the recovery period is influenced by the patient’s age, the degree of impact on the uterus using the laparoscopic method, and the development of postoperative complications. How is the rehabilitation going:
- the first hours - recovery from anesthesia, taking painkillers, antibacterial drugs that reduce the risk of inflammation;
- the first day after removal of the uterus - to stimulate blood circulation, it is recommended to begin gentle physical activity;
- While walking you should wear special stockings, use a bandage, and to clean your lungs you should start inflating balloons;
- in a hospital setting, antiseptic treatment of postoperative wounds is carried out daily;
- seventh day - discharge from the medical institution with a 2-month restriction on heavy physical labor and sexual activity.
After surgery using the laparoscopic method, strict antiseptic treatment of the operated abdominal area is important. The patient will have to apply sterile dressings at home independently.
- Limit hygiene procedures by avoiding hot showers and baths. Washing is only allowed partially so as not to wet the seams. Your personal gynecologist will tell you when you can return to intimate life.
- Do not be alarmed by the appearance of light bleeding from the vagina. The unpleasant consequences of laparoscopic hysterectomy stop spontaneously after a maximum of 3 weeks.
- Monitor your diet from the first days after surgery. After being discharged from the hospital, you can return to eating your usual foods, excluding fried, spicy, fatty foods, and alcohol.
The only drawback of the laparoscopic method is the high cost of surgical manipulation - up to 120 thousand rubles. But the guaranteed possibility of conceiving a child with partial hysterectomy and the high aesthetic effect after laparoscopy will be strong arguments in favor of choosing a modern surgical technique.
Treatment of uterine fibroids without surgery. FUS-MRI method.
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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.
Abroad, removal of the uterus (Hysterectomy) is an operation that is prescribed to many women after 40 years of age to avoid the possible appearance of tumors or the growth of fibroids. This procedure is not uncommon; Although many women are afraid of the possible consequences, this is often the only way to cope with the disease.
Hysterectomy is now one of the most common gynecological operations. After removal of the uterus, a woman loses the ability to become pregnant and bear a child. However, very often there is simply no other way out, since the patient’s life is at risk.
Indications for removal
In what cases is the uterus removed:
The main reasons for hysterectomy are cancer of the ovaries, uterus, or cervix. Often the uterus is removed when fibrosis or fibroids (benign tumor) of the uterus are diagnosed, and less often - with endometriosis. In rare cases, the uterus is removed after childbirth: in case of heavy uterine bleeding caused by injury or postpartum infection.
Preparing for surgery
Hysterectomy is a rather serious matter and the procedure is performed in an inpatient setting.
Hysterectomy is the most common gynecological operation.
Before the operation, doctors conduct a thorough examination and confirm the diagnosis using ultrasound and x-ray methods. A biopsy may also be taken. The patient must undergo a consultation with an anesthesiologist to identify and prevent possible allergic reactions to drugs. The day before removal of the uterus, a special slag-free diet and bowel cleansing with an enema are prescribed. On the day of the procedure, the patient is given a sedative to reduce fear of the operation.
Removal of the uterus, ovaries and appendages
Hysterosalpingo-oophorectomy is an operation in which the uterus is removed along with the appendages and ovaries.
This procedure is the only hope for recovery for many women; in addition, heavy bleeding and severe pain stop, and the constant feeling of discomfort disappears.
Abdominal surgery
If there are no contraindications, then general anesthesia is performed for this operation. In modern German clinics, the operation lasts about 30 minutes. At the site of the incision, a seam approximately 20 cm long remains, it can be horizontal or vertical. It is necessary to wear a post-operative bandage after removal of the uterus for better tissue healing.
Laparoscopic uterus removal
A gentle method of removing the uterus is laparoscopic hysterectomy. This method avoids large abdominal incisions. Laparoscopic removal of the uterus is performed using special equipment:
Small incisions are made in the abdomen through which tubes are inserted; A video camera and the necessary surgical instruments are inserted into the abdominal cavity through tubes; To provide the surgeon with an overview and access to the uterus, the abdominal wall is raised above the organs using gas injected through a special tube - a cannula.
The consequences after removal of the uterus using the laparoscopic method are minimal and postoperative recovery of the body is faster than after abdominal surgery.
“Surgery to remove the uterus” - Video
The video talks about modern gentle methods of performing hysterectomy surgery.
Operation price
How much does a hysterectomy cost? Treatment in Israel is the cheapest.
Practice shows that the level of Israeli medicine is quite comparable to the world, and prices are 30-40% lower.
In general, the cost of a hysterectomy operation in each case is calculated separately and greatly depends on the country, city, level of the clinic and the characteristics of your body. Of course, simple removal of the uterus will cost much less than extirpation - complete removal of the uterus along with the appendages and ovaries.
After operation
Postoperative period
During abdominal surgery, the patient spends about 2 weeks in the hospital. 7 days after the procedure, the doctor removes the staples from the suture. The speed of healing depends on the physiological characteristics of each patient.
If the hysterectomy was global, that is, all ligaments and lymph nodes were removed, then significant changes occur in the pelvic area, which prolong the recovery period after removal of the uterus.
Recovery and rehabilitation
Postoperative therapy is aimed at restoring water and electrolyte balance and blood, as well as preventing inflammatory processes.
It is imperative to pay attention to the psychological aspect: any operation is stressful, and gynecological surgery is a very serious shock for any woman.
Sick leave after hysterectomy is usually issued for a period of 25 to 45 days. Some women tolerate the operation very easily and return to work after 3 weeks.
Diet
In nutrition after removal of the uterus, a woman must adhere to a gentle diet: no aggressive or irritating foods. The following should be excluded from the diet: confectionery, coffee and strong tea, cottage cheese, chocolate, white bread.
To “start” the functioning of the intestines after surgery, you need to eat little by little, but often - 5-7 times a day. Daily water consumption should be increased to 2-4 liters. It is necessary to consume foods that have a weakening effect:
porridge, meat broth, fermented milk group of products.
The basic rule is to strictly adhere to the diet prescribed by the attending physician, both in the first days after completion of the operation and after discharge.
Physical exercise
During the rehabilitation period after removal of the uterus, the loads should be feasible; you should not lift more than 5 kg.
Of course, you need to perform any physical exercises only after the incisions have completely healed, otherwise the stitches may come apart from excessive effort. It would be wise to consult with your doctor; he will tell you which gymnastics after removal of the uterus will be optimal for you.
By the way, many doctors advise getting up and even walking slowly in the first days after surgery. Such moderate physical activity will prevent blood from stagnating in the organs, and the healing process will go faster.
Possible complications
Pain after removal of the uterus may be due to the formation of adhesions or bleeding. These symptoms often appear during the first time after surgery. Also, the consequences of the operation can be thrombosis of the deep veins of the legs, various urination disorders, suppuration of the suture, and hematomas. All these complications significantly prolong the recovery process. Often, after removal of the uterus, women experience all the symptoms of menopause. It is also possible to experience a decrease in libido and vaginal dryness, but such complications are the exception rather than the rule. After removal of the uterus, patients become more susceptible to diseases such as osteoporosis and atherosclerosis.
Discharge after hysterectomy
After removal of the uterus, spotting is possible, since the functions of the ovaries are not affected, and sex hormones affect the cervix. In this case, the main thing is that there is no increase in discharge.
If you have any concerns, you shouldn’t wait for everything to go away on its own. Be sure to consult a doctor for an examination and a correct diagnosis.
If you have any concerns, contact your doctor immediately.
In the following cases, it is necessary to notify the attending physician:
The discharge causes an unpleasant odor, nausea, and fluid incontinence; The presence of large clots in the discharge; The need to change pads multiple times within an hour and the presence of bright red blood discharge from the vagina.
HRT
HRT - hormone replacement therapy - is necessary after removal of the uterus and ovaries, because the body loses the ability to produce hormones on its own without the ovaries. So hormone therapy after hysterectomy is recommended for all women, regardless of age. In fact, this is a replacement for ovarian function lost as a result of surgery.
HRT uses:
gestagens, estrogens, sometimes androgens.
There are a number of contraindications for the use of hormonal drugs after removal of the uterus, which are clarified during a comprehensive gynecological examination.
Reviews
The services of Israeli and German doctors enjoy the best reputation.
In general, the operation for most women is successful and without complications. In addition, foreign clinics carry out postoperative monitoring of their patients. This way the doctor will be able to notice in time if something goes wrong.
To identify diseases in the early stages and diagnose predisposition to them, it is advisable to regularly undergo a comprehensive examination of the body.
In our article at the link you will find out what is included in the examination, where it is best to take it and how much it costs.
You can find more information on this topic in the Gynecology section.
Uterine fibroids are considered the most common benign tumor of the female genital area.
There are many ways to treat this disease, but surgical methods are considered the most effective. One of the popular tactics for myomatous treatment is laparoscopic surgery.
Concept
Even in the recent past, myomatous tumors were removed only through open surgery, which caused many complications such as internal bleeding, adhesions and loss of reproduction.
Today, the laparoscopic technique is considered the best alternative therapeutic solution to open abdominal surgery. Moreover, after laparoscopy, which helps to successfully remove myomatous formations, no traces remain.
The procedure is carried out using special instruments that reach the fibroids through small abdominal punctures. A special video camera is used to visualize what is happening during surgery.
Indications and contraindications
Laparoscopic surgery for uterine fibroids is not always applicable. There is a list of specific indications for such an intervention. Namely:
Multiple or single fibroids with nodes 30-60 mm; Rapid progression and growth of the tumor; When education prevents conception or pregnancy; With a superficial location of fibroid formations; If the nodes put strong pressure on the urinary system and intestines; Subserous myoma formations; The presence of severe forms of iron deficiency anemia caused by heavy bleeding; Impaired blood circulation in the node due to torsion of the leg or other reasons.
Not every patient is allowed to undergo laparoscopic removal of fibroid tumors.
Thus, it is prohibited to remove fibroids in this way for women who have:
Problems with the digestive system, liver pathologies; Hemophilia or hemorrhagic diathesis; Cardiovascular or respiratory pathologies; Suspicion of malignancy of the node; Too many nodes located in the thickness of the uterine wall.
In addition, laparoscopic removal of fibroid nodes is contraindicated in the presence of a hernial process in the peritoneum, insufficient or overweight, ovarian or cervical oncology, large size nodes (more than 12 weeks).
Advantages
Laparoscopic surgery has many advantages compared to other surgical interventions, one of which is minimal trauma and the absence of postoperative marks on the body, which is important for a woman.
Experts note the following advantages of the laparoscopic technique:
This technique is indispensable for surgical intervention in nulliparous patients, since it is organ-preserving and preserves the ability to bear children; Laparoscopic removal of fibroid nodes has a minimal risk of complications during and after the operation; The operation is characterized by low trauma, no risk of bleeding and the development of adhesions; Minimal likelihood of myomatous relapse in the future; Short postoperative recovery period, about 3-4 days; There is no need to take painkillers in the postoperative period, because patients are not bothered by pain.
Unlike abdominal surgery, which requires a large incision in the peritoneum, laparoscopy is performed through small punctures, the traces of which soon become completely invisible.
Types of laparoscopic surgery to remove uterine fibroids
Laparoscopic surgery can be conservative or radical.
With conservative laparoscopy, nodes are removed, i.e., myomectomy is performed. If the patient is indicated for radical laparoscopy, then during such an operation the uterine body is completely removed, i.e., a hysterectomy is performed.
Removal of the uterus while preserving the ovaries ensures a complete loss of menstrual function, however, the appendages continue to function and fully produce hormones. That is why the menopause comes on time and the patient does not have any adverse reactions that are traditionally observed when the ovaries are removed.
Preparation and course of therapy
Preparatory measures for laparoscopic removal of uterine fibroids include laboratory tests and instrumental diagnostics.
Such studies make it possible to identify the presence of specific contraindications and determine the location and nature of the formation.
Laparoscopic surgery begins with pain relief. It is performed through epidural anesthesia or general anesthesia. Then punctures are made in the peritoneum necessary for introducing instruments. Carbon dioxide gas is released into the retroperitoneal cavity, which expands the abdominal walls, which provides more space for surgical manipulations. A laparoscope is inserted into the puncture, which visualizes the uterine body and other organs, and also helps to determine the locations of other punctures (there are 4 of them in total). Z Then the nodes are deleted, and if necessary, then the entire uterus.
The laparoscopic operation lasts no more than 2 hours, and within a few hours after the intervention the patient is allowed to walk.
Complications
Even with such a safe removal of fibroids as laparoscopy, there is a possibility of postoperative complications.
In general, all complications are divided into 2 classes:
Occurring during any laparoscopic interventions or general; Characteristic only for fibroid formations or specific.
Common complications include vascular injuries or intraorganic damage caused by the insertion of devices. In addition, complications may be caused by anesthesia, respiratory disorders, hematomas of the uterine walls, defects due to improper suturing, or infectious complications.
As for specific complications, they may include uterine or fibroid bleeding, hernial processes in the peritoneum, etc. In addition, for the first couple of days the patient will be bothered by nagging painful sensations in the lower zone of the abdominal wall.
If the fibroid nodes are located low or are interstitial in nature, then during laparoscopy the intestinal, bladder structures or ureters may be damaged.
Postoperative period
After laparoscopic surgery for uterine fibroids, the patient is prohibited from any heavy physical activity, however, walking or just walking is simply necessary for a woman at this time to prevent adhesions.
If you are concerned about pain, which is relatively rare, then taking painkillers is recommended. Some ladies are advised to wear anti-varicose stockings, especially those who already have varicose veins.
In the first days of postoperative rehabilitation, experts recommend staying in a hospital, although already on the third day the patient is allowed to go home.
Simply, in a hospital setting under medical supervision, the body will recover, and the blood composition will also normalize. If necessary, the woman is provided with symptomatic therapy, and antibiotic therapy is prescribed to avoid inflammatory complications.
A woman needs to clarify the date of her expected menstruation and the contraceptives that can be used in her case. Protection in this situation is necessary to prevent pregnancy until the full restoration of the uterine body occurs.
Depending on the pathology picture and the operation performed, conception is allowed after a year after laparoscopic removal of fibroids. By this time, the menstrual cycle should be completely normal.
Diet after laparoscopy
Laparoscopic removal of uterine fibroids does not provide for strict restrictions on the diet in the postoperative period, however, you still need to adhere to some restrictions.
Food should ensure the smooth functioning of the intestinal structures so that there is no constipation, which can cause tension in the peritoneum and divergence of the uterine sutures.
In addition to intestinal functionality, the principles 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.
Price
Price parameters for laparoscopic removal of uterine fibroids vary significantly depending on the status of the medical center, its geography, the qualifications of the surgeon and other factors.
On average, laparoscopic surgery will cost 17,000-90,000 rubles. If we talk about foreign clinics, the price of such an operation in the USA is 6,000 euros, in Germany and Israel it is approximately 7,500 euros.
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.
Collapse
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.