Ovarian preservation
The ovaries continue to produce hormones until natural menopause, so after surgery there are no hot flashes, the risk of osteoporosis and cardiovascular disease does not increase - only menstruation stops. The surgeon cuts the own ovarian ligaments, leaving them with blood supply from the infundibulopelvic ligaments, and removes the fallopian tubes (prevention of serous cancer). The operation is performed through a bikini incision with revision of the abdominal cavity; in case of intraoperative detection of ovarian pathology, the volume can be expanded by agreement. The removed uterus is examined histologically.
Indications
- multiple and large uterine fibroids (more than 12–14 weeks) with bleeding, anemia, pressure on neighboring organs;
- adenomyosis, atypical endometrial hyperplasia, recurrent bleeding in perimenopause;
- uterine prolapse (vaginal access), combined with prolapse of the vaginal walls;
- ovarian tumors in combination with uterine pathology, hereditary risk - with removal of the appendages;
- contraindications or impossibility of laparoscopy: very large sizes, adhesions, severe concomitant diseases.
Scope of operation
Amputation (supravaginal) - removal of the uterine body while preserving the cervix with a healthy cervix: in short, with less risk to the ureters; extirpation - removal of the uterus along with the cervix in case of cervical pathology, adenomyosis, hyperplasia; “with appendages” means the simultaneous removal of tubes and ovaries (in postmenopause, with tumors, hereditary risk), “without appendages” - preservation of the ovaries and hormonal function in women before menopause (tubes are usually removed to prevent cancer). Vaginal access (through the vagina) is used for prolapse of the uterus and its small size - without incisions on the abdomen and with the fastest recovery, often together with plastic surgery of the vaginal walls; laparotomy - for a large uterus, adhesions, or the need for revision.
When to choose laparotomy
Open access through a transverse Pfannenstiel incision (along the bikini line) remains the method of choice for very large sizes of the uterus and formations, multiple fibroids with deep nodes, severe adhesions after many operations, suspected malignancy with the need for revision, severe heart and lung diseases in which pneumoperitoneum is undesirable, as well as when laparoscopy is unavailable. Laparotomy gives the surgeon direct control of the tissue and a reliable multi-layer suture on the uterus; the scar after cosmetic suturing is barely noticeable. Recovery is longer than after laparoscopy: hospital stay 3–6 days, exercise limitation 1.5–2 months.
