Amputation of the uterus with preservation of the cervix
The body of the uterus is cut off at the level of the internal os after coagulation of the uterine vessels, the cervical stump is sutured, and the removed organ is crushed in a container and removed through a puncture; The tubes are usually removed, but the ovaries are preserved. Advantages: less duration and blood loss, no suture in the vagina (sex life is possible earlier), less risk of damage to the ureters and prolapse of the dome. The condition is normal cytology and colposcopy of the cervix, since the cervix remains and requires annual screening; In 5–10% of women, scanty cyclic discharge from the remnants of the endometrium in the canal persists. In case of cervical pathology, adenomyosis involving the isthmus, total hysterectomy is chosen.
Indications
- multiple and large uterine fibroids with bleeding and anemia in women who have completed childbearing;
- adenomyosis (internal endometriosis) with pain and bleeding that cannot be treated;
- atypical endometrial hyperplasia, recurrent hyperplasia in perimenopause;
- uterine prolapse (in combination with fixation), chronic pelvic pain;
- precancerous conditions of the cervix, initial stages of endometrial cancer (in gynecological oncology).
Types of hysterectomy
Subtotal (supravaginal amputation) - removal of the uterine body while preserving the cervix: shorter and less traumatic, preserves pelvic floor support, but requires further screening of the cervix; impossible with cervical pathology. Total (extirpation) - removal of the body and cervix: completely eliminates diseases of the cervix and endometrium, the standard for hyperplasia, adenomyosis and cervical pathology. With appendages (hysterosalpingo-oophorectomy) - additionally, tubes and ovaries are removed: for tumors of the appendages, hereditary risk, in postmenopause. In all cases, the tubes are usually removed (cancer prevention) and the ovaries are retained for hormonal function in premenopausal women.
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.
