Large and multiple nodes
The possibility of laparoscopic access for large fibroids is determined by the size (up to 8–12 cm with the experience of the team), the number and location of nodes and the total volume of the uterus; To reduce blood loss, temporary clamping of the uterine arteries, vasopressin, an ultrasonic scalpel are used, and, if necessary, preoperative hormonal preparation. All nodes are removed through a minimum number of incisions on the uterus, each bed is sutured in 2-3 layers, morcellation is performed in a closed container. For nodes larger than 12 cm, deep intramural multiple lesions, or suspected sarcoma on MRI, laparotomy myomectomy is safer. After the operation, control of scars and planning of delivery by cesarean section.
Indications
- uterine fibroids with symptoms: heavy menstruation, anemia, pain, pressure on the bladder and intestines;
- fibroids in infertility and miscarriage, nodes that deform the uterine cavity, before IVF;
- rapid growth of the node, nodes more than 4–5 cm, subserous nodes on a stalk (risk of torsion);
- the desire to preserve the uterus and reproductive function.
How is laparoscopic myomectomy performed?
To reduce blood loss, a vasoconstrictor is introduced into the myometrium, the capsule of the node is dissected with an ultrasonic scalpel or monopolar, the node is removed from the bed, the bed is sutured in 1-2 layers with intracorporeal sutures (the quality of the suture determines the strength of the scar during future pregnancy), the node is crushed in a container (morcellation) and removed through a puncture. The anti-adhesive barrier reduces the risk of adhesions. For multiple, large (>8–10 cm) and deep nodes, as well as for suspected sarcoma, laparotomy or hysteroscopic technique for submucosal nodes is chosen.
Benefits of laparoscopy
Laparoscopy is the standard of modern operative gynecology: magnifying the image by 10–15 times allows you to work more accurately than an open operation and is more gentle on the ovarian tissue and tubes, blood loss is minimal, adhesions form less frequently (important for future pregnancy), the pain after the operation is mild, and the patient gets up on the day of the operation and is discharged on the 1st–3rd day; Instead of a cut, three barely noticeable scars remain. In the clinics below, laparoscopic operations are performed by gynecological surgeons with extensive experience on modern endoscopic stands.
Risks and contraindications
- rare complications: bleeding, injury to neighboring organs, infection, thrombosis - prevention and the experience of the surgeon reduce the risk to a minimum;
- contraindications: severe heart and lung diseases, coagulation disorders, severe adhesions after many operations, large tumors (>15–20 cm) - then laparotomy is chosen;
- Obesity and previous operations are not a contraindication, but require an experienced team.
