Uterine fibroids are considered the most common benign tumor of the female genital area.
There are a lot of ways to treat such a disease, but surgical techniques are considered to be the most effective. One of the most popular tactics of myomatous treatment is laparoscopic surgery.
The concept of
In the recent past, myomatous neoplasms were removed only through an open surgical operation, which caused many complications, such as internal bleeding, the appearance of adhesions and the loss of reproduction.
The procedure is carried out using a special tool that gets to the myoma through small abdominal punctures. To visualize what is happening during the operation, a special video camera is used.
Indications and contraindications
Laparoscopic surgery for uterine myoma is not always applicable. There is a list of certain indications for such intervention. Namely:
- Multiple or single fibroids with nodes of 30-60 mm;
- Rapid progression and tumor growth;
- When education prevents conception or fetal bearing;
- With superficial location of myomoneous formations;
- If the nodes exert strong pressure on the urinary system and intestines;
- Sub-serous myomalous formations;
- The presence of severe forms of iron deficiency anemia, caused by heavy bleeding;
- Disturbed blood circulation at the site due to leg twisting or other causes.
Not every patient is allowed to perform laparoscopic removal of myomoneous tumors.
So, it is forbidden to remove myoma in a similar way to women who have:
- Digestive problems, hepatic pathologies;
- Hemophilia or hemorrhagic diathesis;
- Cardiovascular or respiratory pathologies;
- Suspicion of malignant node;
- Too many nodes located in the thickness of the uterine wall.
In addition, laparoscopic removal of myomontal nodes is contraindicated in the presence of a hernial process in the peritoneum, insufficient or overweight, ovarian or cervical oncology, large node sizes( more than 12 weeks).
Advantages of
Laparoscopic surgery has many advantages over other surgical interventions, one of which is minimal trauma and the absence of postoperative traces on the body, which is important for a woman.
Specialists note in the laparoscopic technique such advantages:
- This technique is indispensable for surgical intervention in nulliparous patients, because it is organ-preserving and retains the ability to bear childbirth;
- Laparoscopic removal of myomal nodes is characterized by a minimal risk of complications during and after surgery;
- Operations are characterized by low traumaticity, no risk of bleeding and development of adhesions;
- Minimal probability of myomatous relapse in the future;
- Short period of postoperative recovery, which is about 3-4 days;
- There is no need to take painkillers in the postoperative period, because the painful feelings of patients do not bother.
Unlike a cavitary operation requiring a large incision on the peritoneum, laparoscopy is performed through small punctures, the traces of which soon become completely invisible.
Types of laparoscopic surgery for the removal of uterine fibroids
Laparoscopic surgery can be conservative or radical.
The removal of the uterus with preservation of the ovaries provides a complete loss of menstrual function, however, the appendages continue to function and produce hormones. This is why the climacteric period comes on time and the patient has no adverse reactions that are traditionally observed when ovaries are removed.
Preparation and course of therapy
Preparations for laparoscopic removal of uterine fibroids are performed in laboratory studies and instrumental hardware diagnostics.
Similar studies can identify the presence of specific contraindications, determine the localization and nature of education.
- Laparoscopic surgery begins with anesthesia. It is carried out through epidural anesthesia or general anesthesia.
- Then in a peritoneum do punctures , necessary for introduction of tools.
- In the retroperitoneal cavity, the carbon dioxide gas is triggered, which expands the abdominal walls, which provides more space for surgical manipulation.
- A laparoscope is introduced into the puncture, visualizing the uterine body and other organs, as well as helping to determine the places of other punctures( 4 in total make them).
- W then removes the nodes, and if necessary, 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 of
Even with such a safe removal of myomas as a laparoscopy, there is a possibility of postoperative complications.
In general, all complications are divided into 2 classes:
- Emerging for any laparoscopic interventions or general;
- Characteristic only for myomas formations or specific.
Among the common complications, one can distinguish vascular injuries or inorganic damage caused by the introduction of devices. In addition, complications can be caused by anesthesia, respiratory disorders, uterine wall hematomas, defects in improper stitching, or infectious complications.
With regard to specific complications, they can consist of uterine or myo-hemorrhages, hernial processes in the peritoneum, etc. In addition, the first couple of days the patient will be bothered by the pulling pain in the lower abdominal wall area.
If the sites of the myomas are low or interstitial, laparoscopy may affect intestinal, uroperitoneal structures or ureters.
Postoperative period
After laparoscopic surgery on uterine fibroids, the patient is not allowed any heavy physical activity, however, walking or just walking to a woman at this time is simply necessary to prevent adhesion processes.
If you are concerned about soreness, which is relatively rare, it is recommended taking pain medications. Some ladies are shown wearing anti-varicose stockings, especially those who already have varicose veins.
In the first days of postoperative rehabilitation specialists recommend being in the hospital, although on the third day the patient is allowed to go home.
Just under stationary conditions under medical control, the body will be restored, the blood composition is also normalized. If necessary, the woman is provided with symptomatic therapy, antibiotic therapy is prescribed to avoid inflammatory complications.
A woman needs to specify the date of expected menstruation and contraceptives that can be used in her case. Prevention in this situation is necessary to prevent pregnancy until a full restoration of the uterine body occurs.
Depending on the pattern of pathology and the operation performed, conception is allowed after one year after laparoscopic removal of myoma. By this time, the menstrual cycle should be completely normalized.
Diet after laparoscopy
Laparoscopic removal of uterine fibroids does not involve strict dietary restrictions in the postoperative period, however, some restrictions must be adhered to.
Food should ensure the smooth operation of intestinal structures, so that there are no constipation that can provoke abdominal tension 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 to cleanse the body of slagging.
In other words, rational nutrition can eliminate several factors that cause the onset of myomatous processes.
The cost of
The price parameters of laparoscopic removal of myomatous uterine formations vary considerably depending on the status of the medical center, its geography, surgeon's qualifications and other factors.
Reviews
In general, the reviews of patients regarding laparoscopic methods of removal of myoma nodes of the uterus are positive, which is explained by the minimal risk of complications, the absence of soreness in the postoperative period and a short rehabilitation period, the absence of cosmetic defects after surgery.
Evgenia:
The myoma, quite large, was removed from several nodes. The doctor recommended laparoscopy. At first I was afraid, I thought for a long time, but after studying a lot of reviews about laparoscopy, I decided to have surgery. Doctors worked clean, removed 3 knots. It's been almost 2.5 years, I do not remember the fibroid. The last examination took place 2 months ago - everything is clean. So do not be afraid of surgery.
Tatiana:
I was diagnosed with myoma, for her treatment the doctor offered laparoscopy. I was satisfied that the complications are minimal, the rehabilitation is short, and there are no traces after the intervention, so I did not think for a long time, I agreed. However, after half a year it turned out that not all the nodes were removed, so a repeated laparoscopic operation was needed. Complications, however, there were no, but because of this medical error, the impression of the operation is not entirely positive. Although in general the punctures quickly healed, and there were no pains after the operation. So, pulled a little, like before the monthly, that's all.
The laparoscopic method of treating myomatous lesions among patients is considered more acceptable, since it is cheaper than other procedures like FUS ablation or embolization, and the risk of relapse is minimal.
The video shows the course of laparoscopic myomectomy with uterine myoma: