Complete removal of the uterus
After the intersection of the round ligaments, tubes and (if preserved) the native ovarian ligaments, coagulation of the uterine vessels and separation of the bladder, the uterus is cut off from the vaginal fornix using a uterine manipulator, removed through the vagina (without morcellation) and the dome is sutured laparoscopically with fixation of the ligaments to prevent prolapse. The absence of a cervix eliminates cervical cancer and the need for cytological screening, and eliminates bleeding completely. Total hysterectomy is mandatory for hyperplasia with atypia, cervical dysplasia, adenomyosis of the isthmus, as well as for initial endometrial cancer (with expansion of the volume by a gynecological oncologist). Sexual activity - 6 weeks after the dome has healed.
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.
