Myomectomy complications. After laparoscopic and conservative myomectomy, the postoperative period

Laparoscopy is a therapeutic or diagnostic intervention on the abdominal organs. During laparoscopy, an optical tube that transmits an image to a monitor screen - a laparoscope - is inserted through a trocar that passes through the abdominal wall. If it is necessary to perform any therapeutic or diagnostic manipulations, other instruments are inserted through additional trocars.

Laparoscopic conservative myomectomy- this is an operation to remove fibroids while preserving the uterus through punctures in the abdominal wall small size. This operation is preferable for women who are planning a pregnancy and for women who want to maintain menstrual function. The technique of laparoscopic myomectomy largely depends on the size, location, and the presence of single or multiple nodes in the uterus.

Laparoscopic surgery to remove uterine fibroids differs from traditional surgery in several key ways.

• During laparoscopic surgery, the surgeon does not look into the abdominal cavity directly through a large incision across the abdomen, and performs the operation while looking at a large video monitor.
• To be successful, the operation itself and especially the suturing of the uterus, which is necessary during a laparoscopic myomectomy, require great hand-eye coordination and dexterity, as well as knowledge of the anatomy of the pelvic area.
• The procedure is safe and effective when performed properly by a well-trained professional. The procedure is actually complex, so greater demands are placed on the training and experience of the doctor performing it than in abdominal surgery.

Conservative removal of fibroids is carried out in four stages:

1. 1. Cutting off and desquamation of myomatous nodes.
2. 2. Restoration of myometrial defects - suturing the uterine wound.
3. 3. Removal of myomatous nodes.
4. 4. Hemostasis and sanitation of the abdominal cavity.

Indications for conservative myomectomy

• The size of uterine fibroids is 12 weeks of pregnancy or more in women of reproductive age.
• The presence of at least one myomatous node with a diameter of more than 3.5 cm in women planning pregnancy.
• The presence of fibroids of any size in case of miscarriage and infertility, if other causes of this problem are excluded.
• Myoma, causing bleeding, due to deformation of the cavity and impaired contractility of the uterus, which leads to anemia in a woman of reproductive age.
• Rapid growth of fibroids - more than 4 weeks of pregnancy per year.
• Pelvic pain syndrome resulting from circulatory disorders in myomatous nodes.
• Dysfunction related bodies (Bladder, intestines) due to their mechanical compression by the tumor.

Contraindications to laparoscopic removal of uterine fibroids

• Decompensation of cardiovascular diseases and respiratory system, diabetes, liver failure, blood diseases and some other diseases. To determine contraindications, consultation with a therapist or specialist of the appropriate profile is necessary.
• Malignant diseases of the endometrium and cervix. If malignancy is suspected, before surgery it is necessary to assess the condition of the organs using oncocytology, but, of course, a biopsy is more informative.
• Severe adhesions after previous operations, as well as obesity of II-III degrees are relative contraindications.
• Carrying out conservative myomectomy for multiple uterine fibroids requires a balanced approach due to the high frequency of relapses (30% and above), while for single nodes it is no more than 10-20%.

Contraindications to performing myomectomy using laparoscopic access are to a certain extent relative and depend on the prevention of bleeding during surgery and the surgeon’s knowledge of the endoscopic suture technique. Despite the advantages of the laparoscopic approach, the treatment of “difficult” fibroids, which have the following characteristics: sizes more than 7-8 cm, located interstitially with centripetal growth, peri-cervical, along back wall of the uterus, intraligamentally and in the area of ​​the uterine rib, previously had limitations. This was associated with a high risk of complications, such as: bleeding during node isolation, the likelihood of conversion (switching to traditional surgery - with laparotomy), the formation of an unreliable scar on the uterus due to poor visualization of the wound in conditions of ongoing bleeding and the active use of electrosurgery in such conditions.

To solve this problem at the High Medical Technologies Clinic named after. Since 2010, N.I. Pirogov has been using the technique of temporary preoperative embolization of the uterine arteries. Thanks to this, we are able to solve the problems of the standard technique of laparoscopic myomectomy: the operation is performed without blood loss, with minimal electrosurgical effect on the myometrium, which allows us to isolate the node without trauma to surrounding tissues and reliably suturing wound on the uterus under conditions of good visualization. And this is necessary for subsequent pregnancy and childbirth.

Postoperative period

After laparoscopic operations, 4 incisions 5-10 mm long remain on the skin of the abdomen. From the first day, patients begin to get out of bed and take liquid food. They are discharged from the hospital on days 4–6. It should be noted that the scars remaining on the uterus after this type of procedure surgical intervention, require increased attention when managing pregnancy and childbirth in these patients.

Benign neoplasms in the organs of a woman’s reproductive system are, unfortunately, being detected more and more often these days. Almost every fifth woman who turns to a gynecologist learns that he has such an ailment as uterine fibroids - a benign tumor that, in the absence of timely treatment tends to degenerate into cancer. Myoma is a node with a connective tissue structure formed on the wall of the uterus.

Please note that this text was prepared without the support of our website.

Myomatous nodes must be removed, most often surgical methods. One of them is myomectomy. The essence of this operation is to remove the fibroids; the uterus remains intact after myomectomy. Thanks to the preservation of the reproductive organ, a woman can become pregnant in the future and bear a child. The recovery period after removal of uterine fibroids by this method does not last long, during which the patient should adhere to certain prohibitions and restrictions. After myomectomy, the chances of pregnancy for a woman with uterine fibroids increase, but there is still no 100% guarantee of success, since a postoperative scar on the uterus after myomectomy can become an obstacle to the normal course of pregnancy and childbirth.

An alternative to myomectomy is more modern way fight against fibroids – uterine artery embolization (UAE). This method characterized by less invasiveness and at the same time much higher efficiency than other operations, it is used in most leading specialized clinics, a list of which is provided.

Recovery after different types of myomectomy

Depending on what technology was used for the operation, postoperative period It can be short-lived and unnoticeable, or, conversely, it can be long and painful. Laparoscopic and hysteroscopic myomectomy are considered the most gentle - operations that do not involve performing abdominal incisions. Using special surgical devices - a laparoscope and a resectoscope, tumors on the uterus are removed through incisions small size on the abdominal wall or through the vagina. Therefore, the duration of the postoperative period is only a few days. After myomectomy via abdominal surgical approach recovery period lasts much longer, since during the operation the abdominal cavity is dissected. With special features surgical treatment on the uterus can be found.

Myomectomy: rehabilitation in the first days

Regardless of the method of myomectomy, the woman needs medical supervision for the first day after surgery. The attending physician must be convinced that the patient’s condition is satisfactory, and then make an appointment for her medicines antibacterial and analgesic effects. Similar additional treatment after surgery prevents the development negative consequences. Sometimes after a surgical intervention such as myomectomy, complications develop in the form of uterine bleeding, edema, hematomas. This symptomatology is caused by damage to the great vessels, trauma to nearby organs, as well as internal inflammatory processes and infection, which requires immediate treatment. Such conditions are characterized by increased body temperature and pain in the postoperative area.

Pain after myomectomy

The intensity of pain after conservative myomectomy depends on what method was used to perform the operation to remove the node on the uterus. The postoperative period is most painless after hysteroscopic myomectomy, for which the integrity of the skin, and pathological formations are excised with a special device - a resectoscope, through the vagina. Provided the nodes are located in a well-accessible place, recovery, accompanied by pain, usually lasts no longer than a day.

After laparoscopic removal of uterine fibroids painful sensations also last a short time, since the size of the incisions for introducing trocars and surgical instruments into the uterus is very small, due to which this type The operation is considered gentle and low-traumatic.

The most invasive is abdominal myomectomy, accompanied by intense pain. The operation lasts several hours, so it requires the use of strong painkillers. The postoperative period after removal of uterine myomatous formations using the abdominal method due to the need for abdominal incisions and the use of general anesthesia lasts longer than after other methods of surgery.

Least of all pain syndrome expressed after a minimally invasive UAE procedure, which is due to the special technique of its implementation, the absence of the need to make even the slightest incisions. All the details of the procedure and its consequences are described in detail.

Discharge after myomectomy

Slight bleeding after hysteroscopic surgery is considered normal occurrence. They are caused by injury to the vaginal walls with a resectoscope inserted through it into the uterine cavity. For wound healing, the use of medicinal ointments and sexual rest are recommended.

Discharge from the uterus after other types of myomectomy should normally be transparent, without unpleasant odor that do not cause itching.

Correction of nutrition after myomectomy

During the recovery period after surgery, a woman is recommended to change her diet. Because constipation and gas may increase intra-abdominal pressure and promote rupture surgical sutures If there is no bowel movement for 24 hours, the woman should take a mild laxative.

After myomectomy, the diet should be based on easily digestible foods. Preference should be given to crumbly cereals, fermented milk products, fresh vegetables and fruits.

Rice should be excluded from the diet, semolina porridge, jelly, strong tea, full-fat sour cream and cottage cheese. The process of gas formation intensifies after consuming legumes, milk, grapes and baking from yeast dough; the above-mentioned products should also be avoided.

Physical activity after myomectomy

In the postoperative period after surgical removal myomatous formations, a woman needs to take care of herself, avoid squats, lifting heavy things, and standing on her feet for a long time. By strictly following these restrictions, you can achieve a speedy recovery and a quick return to normal life.

However, it is undesirable to abuse bed rest during this period. Active blood circulation throughout the body prevents the formation of adhesions and fills cells with oxygen. After myomectomy, it is recommended to take walks in the fresh air, alternating them with rest breaks, during which you can sit on a bench in a public garden or park.

Prohibitions and restrictions in the postoperative period after myomectomy

During the rehabilitation period after myomectomy, there are some prohibitions.

Women should avoid overheating the body, visiting the beach, solarium and saunas. By neglecting these prohibitions, they risk creating conditions for the formation of new myomatous formations. In addition, you must wait at least one year before planning a pregnancy. During this period, all organs of the reproductive system will restore their functions, and the body will replenish its strength necessary to bear a child.

Considering that the use alcoholic drinks and smoking have a suppressive effect on the immune and excretory systems; in addition, alcohol is not compatible with antibacterial drugs and promotes thrombus formation, from these bad habits A woman should abstain for at least one month after myomectomy.

Some prohibitions also apply to the choice of clothing and underwear. It is recommended to give preference to comfortable models made of natural materials, abandoning slimming models made of synthetic fabric. When choosing a wardrobe, a woman should take into account that squeezing the operated area and rubbing the skin around the postoperative suture can significantly harm recovery.

For the purpose of prophylaxis to prevent relapse of the disease, a woman is recommended to adhere to healthy image life, give up bad habits, consult a doctor in a timely manner about gynecological problems. Be sure to visit a doctor for a preventive examination and at the slightest alarming symptoms.

Despite the seemingly insignificant consequences of myomectomy, it is a rather serious surgical intervention on the female body and often threatens the development of complications. In addition, it does not provide a lifelong result - after surgery there is a high risk of relapse of the disease.

More effective way The treatment for uterine fibroids is uterine artery embolization (UAE). This minimally invasive procedure is performed in most modern gynecology clinics. After UAE, there are no relapses, there is practically no pain, there are no postoperative scars on the body, the integrity of the uterus is preserved: there is no scar on the uterus, and most importantly, both the menstrual and reproductive functions of the woman are preserved.

You can make an appointment with leading specialists in the field of endovascular surgery and ask them questions regarding the nuances of UAE by calling to the indicated numbers.

Bibliography

• Lipsky A. A.,. Gynecology // encyclopedic Dictionary Brockhaus and Efron: in 86 volumes (82 volumes and 4 additional). - St. Petersburg. 1890-1907.
• Bodyazhina, V.I. Textbook of gynecology / V.I. Bodyazhina, K.N. Zhmakin. - M.: State Publishing House medical literature, 2010. - 368 p.
• Braude, I. L. Operative gynecology / I. L. Braude. - M.: State Publishing House of Medical Literature, 2008. - 728 p.

07 November 2017 7129 0

Conservative myomectomy is surgery, during which the fibroid is removed. At the same time, the integrity of the reproductive organ, and, consequently, the reproductive function of the woman is preserved. Surgery can be performed hysteroscopically, laparoscopically or abdominally. In addition, today a minimally invasive method such as UAE is used to treat uterine fibroids. Thanks to its high efficiency and absolute safety, the popularity of UAE among doctors and patients is constantly growing.

Please note that this text was prepared without the support of our website.

Make an appointment the best specialists Moscow: endovascular surgeon, candidate of medical sciences Bobrov B.Yu., gynecologist, candidate of medical sciences Lubnin D.M. Can

Hysteroscopic uterine myomectomy

Hysteroscopic myomectomy is a method of surgical treatment of uterine fibroids with submucosal localization and growth directed into the lumen of the organ. The operation does not require an incision. Hysteroscopic myomectomy is performed with a special device - a resectoscope, which is inserted into the uterine cavity through. This intervention requires the use of anesthesia.

Hysteroscopic myomectomy: indications

Hysteroscopic myomectomy is indicated for the following conditions:

• submucosal localization of the myomatous node;
• uterine fibroids growing on a stalk;
• metrorrhagia and menorrhagia, provoking the development of anemia;
• infertility and miscarriage.

Hysteroscopic myomectomy: contraindications

Hysteroscopic myomectomy is contraindicated in the following cases:

• with a uterine depth of more than 12 cm;
• with endometrial hyperplasia or adenocarcinoma;
• at infectious diseases organs of the reproductive system;
• for severe pathologies of the liver, kidneys and heart;
• with leiomyosarcoma.

Removal of sutures after myomectomy is performed after 10-14 days. Restoration of working capacity usually occurs after 1.5-2 months.

Hysteroscopic myomectomy: consequences

This surgical intervention may be accompanied by the following complications:

• damage to the peritoneal organs, blood vessels, disruption respiratory function;
• intraoperative complications that require uterine resection;
• the appearance of hematomas on the wall of the uterus, invasion of infection;
• damage to the pelvic organs;
• hernias of the anterior abdominal wall;
• formation of scars on the organ;
• development of relapses (observed in almost 30% of women).

Laparoscopic myomectomy

Laparoscopy (myomectomy) is used for subserous and intramural uterine fibroids. The essence of the operation is the introduction into the abdominal cavity of a laparoscope equipped with a video camera and other surgical instruments, which is designed to remove the node through small incisions. Anesthesia is required to perform the procedure.

Conservative myomectomy, performed laparoscopically, ensures the preservation of a woman’s reproductive and menstrual function.

Before surgery, a woman needs to take basic hormonal drug(gestrinone, goserelin), which helps to reduce the size of the node and reduce bleeding time during surgery. Hormonal treatment is necessary when the size of the myomatous node exceeds 5 cm. For a myomatous node of subserous localization on a pedicle, preoperative preparation is not carried out.

Laparoscopic myomectomy: indications

Myomectomy using a laparoscopic approach is recommended for the following indications:

• subserous uterine fibroids growing on a stalk;
• infertility and miscarriage;
• metrorrhagia, menorrhagia, complicated by the development of anemia;
• rapid development or large size of uterine fibroids (more than 10 cm);
• pelvic pain associated with impaired blood flow in the myomatous node;
• disruption of the activity of nearby organs when they are compressed by a tumor;
• combination of uterine fibroids with other diseases, the treatment of which requires surgical removal.

Laparoscopic myomectomy: contraindications

Laparoscopic myomectomy is contraindicated in women with the following conditions:

• diseases of the cardiovascular, respiratory system, hemophilia, liver failure, diabetes mellitus, complicated hemorrhagic diathesis;
• malignant neoplasms of the internal genital organs;
• if the tumor size is more than 10 cm after taking hormonal drugs;
• multiple interstitial nodes (more than four).

Laparoscopic myomectomy is relatively contraindicated in patients with grade 2-3 obesity and adhesions.

Laparoscopic myomectomy: postoperative period

On the first day after myomectomy, the patient is recommended to remain in bed, due to the use of anesthesia. In the evening you are allowed to drink some still water. You can get up and eat on the second day after your myomectomy. Recovery after surgery lasts 2-5 days, after which the woman can be discharged from the hospital.

For the first 14 days, you must stop taking baths and treat wounds with a 5% solution of potassium permanganate or iodine. You can return to your normal lifestyle in two to three weeks.

A woman should monitor her discharge after myomectomy. Normally, after hysteroscopy they may be bloody and light. The appearance of such discharge is due to the fact that during the process of inserting a resectoscope into the uterine cavity, the vaginal walls may be injured. Used as wound healing agents medicinal ointments. In addition, the patient needs sexual rest for some time. Other types of myomectomy may be accompanied by the appearance of clear discharge that does not have an unpleasant odor or cause itching.

Full recovery of the body occurs in different terms- depending on whether the patient has accompanying illnesses(obesity, diabetes, arterial hypertension and etc.). Having sex after surgery should be postponed for one to one and a half months.

After myomectomy, a woman needs regular visits to a gynecologist and an ultrasound examination to monitor the condition of the uterus.

Conservative laparoscopic myomectomy: reviews after surgery

According to experts, laparoscopic myomectomy is less traumatic than other methods of surgical treatment of uterine fibroids. In addition, after laparoscopy, the duration of the postoperative period is significantly shorter. On the first day after surgery, a woman needs narcotic analgesics. Antibacterial medications are prescribed according to indications. medications. Rehabilitation period In hospital, as a rule, it lasts no more than seven days.

Full restoration of ability to work is observed one month after myomectomy. If myomatous nodes are removed from the posterior vaginal vault, the woman will have to give up sexual activity for a period of about one to two months after the operation.

Pregnancy after conservative myomectomy

If present on the uterus postoperative scar, pregnancy should be planned no earlier than two years after myomectomy. During this period, experts do not recommend using intrauterine contraception.

To assess the degree of scar consistency, instrumental studies: ultrasonography(ultrasound), hysteroscopy, hysterosalpingography. If conception occurs earlier than two years after myomectomy and if there are no objective signs of scar failure, pregnancy is not contraindicated, but the woman needs constant monitoring by a specialist.

Scars can cause complications during pregnancy and lead to rather disastrous consequences: termination of pregnancy, placental insufficiency (when the placenta is fixed in a damaged area of ​​the uterus).

In such situations, blood circulation is disrupted between expectant mother and the fetus, as a result of which the latter may develop hypoxia. In addition, there is high risk rupture of the uterus along the scar.

Hormonal therapy after conservative myomectomy

After myomectomy, the patient needs dynamic monitoring, clinical examinations, and transvaginal echography. As a rule, after surgery an appointment is made antibacterial drugs to prevent infection.

As is generally accepted, uterine and cervical fibroids are a hormone-dependent tumor, therefore it is advisable to use anti-estrogenic drugs, androgenic hormones, estrogen-gestagen drugs and GnRH analogues.

Despite the positive results of treatment of uterine fibroids with surgical and by medication, most effective method To combat this disease, embolization of the uterine arteries is currently considered.

UAE is a modern, absolutely painless, minimally invasive and organ-preserving endovascular method for the treatment of uterine fibroids. Within three to six months after UAE, myomatous nodes significantly decrease in size, and after a year the tumor completely disappears.

Modern clinics offering UAE are equipped with modern high-tech angiographs, with which doctors have the ability to scan, visualize the smallest vessels and perform an endovascular procedure without incisions. A list of leading clinics where UAE can be done is presented.

Bibliography

• Savitsky G. A., Ivanova R. D., Svechnikova F. A. The role of local hyperhormonemia in the pathogenesis of the growth rate of tumor nodes in uterine fibroids // Obstetrics and Gynecology. – 1983. – T. 4. – P. 13-16.
• Sidorova I.S. Uterine fibroids (modern aspects of etiology, pathogenesis, classification and prevention). In the book: Uterine fibroids. Ed. I.S. Sidorova. M: MIA 2003; 5-66.
• Meriakri A.V. Epidemiology and pathogenesis of uterine fibroids. Sib Med Journal 1998; 2: 8-13.

Myomectomy is the most comfortable method of removing a tumor while preserving a woman’s reproductive function. The gentle operation allows you to radically get rid of fibroids, so young women who are planning children in the future willingly agree to it. Application of modern endoscopic technologies and completely takes myomectomy to a different level, making the procedure almost bloodless and relatively safe. Minimally invasive surgeries allow a woman to recover fairly quickly and return to her normal life without significant restrictions.

In modern gynecology, conservative myomectomy is a good alternative to radical removal of the uterus, but does not replace other treatment methods. With the introduction of UAE (uterine artery embolization) into practice, tumor enucleation fades into the background, giving way to more comfortable and safe methods. At the same time, myomectomy does not lose its position in the treatment of single intermuscular formations, submucosal and subserous nodes on the leg, as well as in situations where other treatment methods are not available to the patient.

Pros and cons of conservative myomectomy

Advantages of conservative myomectomy:

• Possibility of immediate tumor removal;
• Preservation of the uterus and reproductive function;
• The possibility of carrying out the operation not only open, but also;
• Availability: the majority of practicing gynecologists are proficient in the myomectomy technique.

The disadvantages of the methods include:

• Probability of relapse: according to statistics, within 5 years, 70% of patients have fibroids again;
• There is a certain risk of complications, as with any operation;
• When performed, a scar remains on the uterus - an indication for a planned cesarean section;
• Technical difficulty of implementation for multiple interstitial fibroids.

The final choice of treatment tactics is determined after full examination patients and assessment of all risk factors.

Carrying out conservative myomectomy laparoscopically.

Indications for surgery

Tumor enucleation is possible in the following situations:

• Submucosal (submucosal node) on a stalk, completely protruding into the uterine cavity (type 0 according to the FIGO classification) measuring up to 10 cm;
• Submucosal tumor, partially protruding into the uterine cavity (FIGO types 1 and 2);
• (including on the leg);
• Interstitial fibroid with a small number of nodes;
• Size of the uterus up to 12-14 weeks;
• Infertility or miscarriage due to diagnosed fibroids (in the presence of at least one node measuring 3 cm or more).

Before the introduction of UAE into practice, patients with multiple interstitial fibroids were often offered a radical solution - removal of the uterus. Today Embolization allows you to get rid of myomatous nodes with a guarantee while preserving the woman’s reproductive function. In this case, EMA is the method of choice.

If embolization is not available for one reason or another (the clinic does not have equipment or a doctor who knows the technique), the doctor can perform a conservative myomectomy for intermuscular fibroids, but the outcome of such an operation will not always be favorable. Often the surgeon has to excise quite large plot healthy tissue, and in the future the injured uterus will not be able to perform its main function - bearing a fetus.

On a note

If UAE is not possible, and conservative myomectomy is associated with great risks, the doctor can offer only one option to a patient with children - removal of the uterus. Technically more simple operation and besides, it allows you to solve the problem with a guarantee.

Carrying out UAE for multiple uterine fibroids.

Contraindications to breast-conserving surgery

Conservative myomectomy is not advisable in the following situations:

• The size of the uterus is more than 14-16 weeks in the presence of multiple nodes;
• A woman's reluctance to have children in the future;
• Premenopause and menopause;
• Confirmed or suspected uterine sarcoma;
• when it is technically difficult to perform a myomectomy without serious consequences for the patient;
• Reduction of fibroids after surgery;
• when other methods have proven ineffective;
• The size of the node is more than 10 cm even after preoperative preparation with hormonal drugs;
• Development of complications life-threatening women.

Myomectomy according to Morrow is a rather traumatic operation, and often when the node is enucleated, it opens heavy bleeding. In this situation the only way The only way to save the patient is to remove the uterus.

The operation is not performed for acute infectious diseases, as well as exacerbation of chronic pathology. In this case, the procedure is performed after full recovery or achieving remission.

Preparation: what to do before surgery

List of mandatory tests required for myomectomy:

• Blood tests: general and biochemical, coagulogram, determination of blood group and Rh factor;
• Blood for syphilis viral hepatitis, HIV;
• General urine analysis;
• Smear for flora and oncocytology;
• ECG and consultation with a therapist;
• Examination by a gynecologist;
• Ultrasound of the pelvic organs with Doppler ultrasound (assessment of tumor blood flow).

Assessment of fibroid blood flow by ultrasound.

If concomitant pathology is detected, additional examinations are carried out.

3-6 months before surgery, the doctor may prescribe the goal of treatment - to reduce the diameter of the formation and reduce the likelihood of blood loss when removing the node. This tactic is shown when multiple fibroids and tumor sizes greater than 5 cm. UAE can be used as an alternative to hormones.

Technique of conservative myomectomy

There are several options for performing the operation:

• Laparotomy myomectomy – classical access through an incision on the anterior abdominal wall and uterus;
• Laparoscopic surgery - through small punctures without opening the uterine cavity;

The choice of method will depend on the location, number and size of nodes, as well as the technical capabilities of the clinic. By compulsory medical insurance policy myomyectomy is performed free of charge in state clinic. The cost of surgery in private clinics in Moscow ranges from 100 to 150 thousand rubles, depending on access, volume and complexity of the procedure.

On a note

Myoma removal is carried out in the first week menstrual cycle– usually for 5-10 days.

Laparotomy with myomectomy

Applicable in the following situations:

• As an alternative in clinics where there is no technical possibility of performing laparoscopy or hysteroresectoscopy;
• The size of the uterus is more than 12 weeks;
• The total number of myomatous nodes is more than 4 (especially with an interstitial location);
• Low location of the tumor: cervix or isthmus.

Progress of the operation:

1. Transsection - incision of the skin, subcutaneous tissue and muscles, opening of the abdominal cavity;
2. Incision of the uterine wall and opening of the tumor capsule;
3. Enucleation of the tumor from the capsule;
4. Stopping bleeding and suturing/cauterizing the tumor bed;
5. Layer-by-layer suturing of the uterus and overlying tissues.

Removal of myomatous node using open access.

On a note

Feedback from women about this method of treatment is quite contradictory, which is explained by the large number of complications. Laparotomy is a fairly traumatic operation that requires long-term anesthesia. After recovering from anesthesia, many patients report the appearance of nausea, headaches and other unpleasant symptoms. Recovery after laparotomy is quite long - up to 4-6 weeks. In addition, care is required postoperative suture. If possible, doctors try to do without an incision, but in some cases it is simply impossible to perform myomectomy using an endoscopic approach.

Laparoscopic myomectomy

The fundamental difference from the classical operation is that here the surgeon does not open the abdominal cavity and does not make an incision in the uterus. An endoscopic instrument is inserted into the pelvic cavity through neat holes (in the navel area and on the sides of the pelvis), and with its help the doctor performs all the necessary manipulations: excision of the formation, cauterization of the bed, removal of the tumor through a puncture. The doctor controls his actions using a video camera, which displays all the information on the screen at the operating table.

Laparoscopic myomectomy has certain advantages over classical surgery:

• Fast recovery after the procedure;
• Relatively low risk of complications;
• There is no incision in the uterus, which means that a woman will most likely be able to give birth to a child through natural birth canal.

Stages of laparoscopic myomectomy: 1. Capture the fibroid with instruments. 2. Dissection of the capsule of the node and its enucleation. 3. Treatment of the fibroid bed. 4.Remote node.

On a note

According to numerous reviews of women who have undergone laparoscopic surgery, it is clear that tumor removal is rarely accompanied by complications. The postoperative period takes about 2 weeks. In the absence of complaints and complications, the patient can be discharged home on the second or third day after endoscopic surgery. There is no scar left on the skin - only almost imperceptible marks from instrument punctures.

Indications for laparoscopic myomectomy:

• Subserous and up to 8-10 cm in size;
• The total number of tumors is up to 4.

Laparoscopy is usually not performed for severe adhesive process in the pelvis, obesity of degree II and above, as well as with multiple interstitial fibroids. An experienced gynecologist can undertake surgery even under such conditions, but the outcome of the manipulation is not always favorable. With the introduction of electromechanical morcellators into practice, it became possible to carry out

laparoscopic myomectomy and for large formations (up to 15 cm), however, not every clinic has such equipment, and not every surgeon is fully proficient in this technique.

Hysteroresectoscopic myomectomy

• Indications for surgery:
• Submucosal nodes on a stalk up to 10 cm in diameter;

Submucosal formations, partially located in the myometrium (subject to preliminary preparation - reduction in tumor size using UAE or hormonal therapy).

Hysteroresectoscopy is the method of choice when removing submucosal nodes, especially for women planning pregnancy. During the operation, no incision is made into the uterus, no scars are left, and in the future there are no obstacles to bearing a child and natural childbirth.

• There are two options for performing hysteroresectoscopy:
• Mechanically - excision of fibroids with a scalpel, unscrewing the tumor stalk with forceps. Used for knot sizes of 5-10 cm;

Electrosurgical myomectomy using a wire loop. Indicated for tumor diameters up to 5 cm. Myomectomy using hysteroresectoscopy is performed on an outpatient basis under anesthesia or local anesthesia

. The doctor dilates the cervix and inserts a hysteroscope through it, after which he carries out all the necessary manipulations to remove the tumor.

On a note

Removal of myomatous node by hysteroscopic method.

According to reviews, hysteroresectoscopy is well tolerated by women. The operation takes only 15-20 minutes, does not always require general anesthesia, and is rarely accompanied by complications. 2 hours after removal of the fibroids, the patient can be sent home.

Possible undesirable consequences of surgical treatment

After a myomectomy, the following complications may develop:

Bleeding One of the most dangerous complications

• arising in the early postoperative period. For this reason, not all gynecologists undertake myomectomy with multiple interstitial nodes, fearing excessive blood loss. To reduce the risk of such complications, one of the following regimens is used:
• Preoperative course of hormones;

Temporary occlusion of the iliac arteries during surgery.

It happens that after surgery, periods do not come on time or take too long – more than 7 days. It is also possible that intermenstrual bloody discharge(“daubs”). An operation is a powerful stress for the body, and it is not surprising that against this background, hormonal disbalance. The cycle should be restored within three months. If the problem persists, you should see a doctor.

Infection

There should be no pain after fibroid removal. Some discomfort persists up to 7 days after surgery, but later this discomfort goes away. If after myomectomy your stomach hurts and your body temperature rises, it is possible that an infection may develop in the uterine cavity. In favor inflammatory process speaking and appearance purulent discharge from the genital tract. A gynecological examination and ultrasound will help determine the diagnosis.

Seam divergence

A rare complication that occurs when improper care behind the suture area or if the technique of its application is violated. The sutures can also become infected, which is accompanied by pain and the appearance of purulent discharge. In this situation, antibiotics and wound washing with antiseptics are indicated. Repeat surgery may be required.

It is very important to properly care for the postoperative wound to prevent the development of complications.

Adhesive process

This complication often occurs after abdominal surgery. The appearance of adhesions is accompanied nagging pain in the lower abdomen and in its lateral sections. Synechia fallopian tubes can lead to the development of ectopic pregnancy or cause infertility. If the fallopian tubes are completely obstructed, IVF is indicated.

Growth of new nodes

Statistics indicate that myomectomy is not a panacea. After 5-10 years, most patients experience a relapse of the disease. This may be a tumor arising from the remains of a node after myomectomy, but the formation arises in another place of the uterus.

That is why gynecologists do not advise delaying the birth of a child and recommend planning a pregnancy 6-12 months after the operation.

It is important to know The menstrual cycle after surgery is restored quite quickly, and theoretically, conception of a child can occur already in the first month after removal of fibroids. For this reason, gynecologists strongly advise using protection in the first months after surgery. Early pregnancy

The condition of the uterine scar after conservative myomectomy can be assessed using ultrasound. Control examinations are carried out 1, 6 and 12 months after surgery. Until the doctor declares a fully formed scar, you should not become pregnant.

Ultrasound after surgery allows you to assess the condition of the scar and the presence of fibroid recurrence.

Childbirth after myomectomy can occur through the natural birth canal only in two situations:

• There is no scar on the uterus (after hysteroscopic surgery);
• In the presence of a wealthy scar (according to ultrasound results).

In other situations it is shown C-section as planned. It is worth noting that doctors often play it safe and recommend surgical delivery to all women who have undergone a myomectomy with opening of the uterine cavity. This tactic is justified, because even with a full-fledged scar, there is a risk of complications:

• Low placenta attachment or placenta previa with possible bleeding;
• Rupture of the uterus along the scar during pregnancy or childbirth.

Uterine fibroids are a benign tumor that can subsequently develop into cancer. Myomectomy is an operation in which fibroids are removed and the uterus is preserved. Due to the fact that such surgical intervention allows a woman to preserve her reproductive organ, in the future she can become pregnant and give birth to a child without any problems.

After myomectomy, the chances of pregnancy increase, however, confidence in positive result is still missing. IN medical practice There are several types of myomectomy, but their main goal is to remove nodules in the uterine cavity in the most gentle way, and to prevent disruption of the reproductive function of the female body. Reviews about various types Myomectomies are quite diverse, because each of them has its own characteristics and consequences.

Features of fibroids

Uterine fibroids can range in size from a small nodule to a tumor weighing about a kilogram, when it is easily identified by palpation of the abdomen.

Uterine fibroids are often diagnosed in women of reproductive age, however, this does not exclude the possibility of its development at any period of life.

The danger of this disease lies in its asymptomatic course, which does not allow a woman to promptly seek help from a specialist and undergo treatment.

Only a small proportion of patients exhibit signs of fibroids and changes in the uterine cavity that require emergency surgical intervention.

We can highlight the most clear signs diseases that indicate the need for surgery:

• periodic bleeding from the uterine cavity and heavy menstruation;
• the appearance of pain in the lower abdomen;
• a feeling of heaviness and pressure on nearby organs;
• unpleasant and discomfort during sexual intercourse;
• the tumor grows very quickly.

In the event that uterine fibroids cause changes of various nature myometrium and heavy menstruation, this gradually leads to the development of anemia. In addition, unpleasant symptoms such as:

• increased weakness of the body;
• severe dizziness;
• decline protective functions body;
• disruption of the cardiovascular system.

Diagnosis of uterine fibroids leads to pregnancy proceeding with various complications. In addition, when the tumor is localized under the uterine mucosa, the process of embryo implantation is disrupted and the likelihood of spontaneous miscarriage increases. Myomatous nodes can cause blockage and deformation of the fallopian tubes, as a result of which pregnancy may not occur a long period time. If pregnancy does occur, the risk of premature birth increases.

Often uterine fibroids are removed along with the uterus, however, this type of operation is not suitable for everyone. Experts do not use this treatment in young women who do not have children and are planning a pregnancy in the future.

The most effective and gentle treatment method in this situation is considered to be myomectomy, which involves only removing the tumor while preserving the uterus.

In the event that a scar remains on the uterus, then childbirth after it can take place either independently or by cesarean section.

Laparoscopy of fibroids

Laparoscopic myomectomy is one of the methods for removing benign neoplasms myometrium in the uterine cavity, one of which is fibroids. Most often, such a benign tumor is localized in the uterine cavity and only in some cases does it affect the cervix of the organ or the area of ​​the associated apparatus. The scar after the operation is hardly noticeable and childbirth after such an operation most often goes away on its own.

Benefits of the procedure

Reviews about this procedure among women are mostly positive and the popularity of this method is explained by its following features:

• such an operation is performed with minimal blood loss;
• the risk of injury to nearby organs is very low;
• after such an operation, the seam and scar are almost invisible;
• the likelihood of formation of adhesions is reduced;
• recovery takes only a few days;

The woman retains the opportunity to become pregnant soon and childbirth usually occurs without complications.

Indications for laparoscopy

The laparoscopic myomectomy operation is performed in cases where a woman is diagnosed with large myometrial nodes, as well as single neoplasms with a specific structure. The consequences of their presence are not entirely pleasant and their presence in the uterine cavity does not allow a woman to become pregnant. In addition, labor may begin ahead of schedule and the development of some pathological processes is possible:

• fibroids cause pain and changes in the myometrium of the uterine cavity and disrupt contractile function, which leads to the development of anemia, and also observed frequent bleeding and heavy periods;
• observed fast growth benign tumor;
• pain appears and this is due to poor circulation in the area where it is localized;
• the growth of fibroids puts pressure on nearby organs and this disrupts their normal functioning;
• there is an increased chance that the pregnancy will end spontaneous miscarriage or premature labor will begin
• the threat of reproductive dysfunction increases.

Features of the operation

Laparoscopic myomectomy requires certain preparation, which consists of prescribing a course of certain medications. Their action is aimed at reducing the size of uterine nodes and reducing blood loss during surgery. Often hormonal treatment is prescribed only if the size of the myometrial fibroid nodes exceeds 4-5 cm. In the event that the fibroid node is subserous localized, then preoperative preparation is not carried out in this case. Reviews from patients indicate that this type of surgery is well tolerated by the female body.

During the operation, a special device is used - a laparoscope, which is directly inserted into the abdominal cavity.

To do this, four punctures are made on the anterior abdominal wall, into one of which a laparoscope is inserted. The remaining three punctures are intended for the introduction of surgical manipulators. In addition, for the convenience of laparoscopy, carbon dioxide is injected into the abdominal cavity.

Contraindications to laparoscopy

Despite the fact that reviews of laparoscopic myomectomy are almost all positive, such an operation often has some limitations. This kind surgical intervention It is not recommended for women in the following cases:

• diagnosing pathologies that are accompanied by impaired respiratory function and cardiovascular activity;
• complicated hemorrhagic diathesis;
• renal failure of acute and chronic nature;
• there is a suspicion of progression to female body malignant neoplasms;
• identification large quantity fibroids, the location of which is the myometrial region.

Only a specialist makes a decision to perform laparoscopic myomectomy and he does this taking into account the complexity of the pathology and individual characteristics female body.

Reviews from women indicate that the rehabilitation period lasts about three months, and a woman can plan a pregnancy six months after the procedure. Childbirth after laparoscopy can proceed as follows: naturally, and by caesarean section.

Hysteroscopy of fibroids

Hysteroscopic myomectomy is an operation to remove a benign tumor through the vagina and cervix.

Indications for surgery

Most often, this type of surgical intervention is performed in the following cases:

• diagnosing a woman with submucous fibroids;
• identification of fibroids on the leg, which causes severe pain;
• heavy bleeding and menstruation, leading to the development of anemia;
• pregnancy does not occur for a long time or ends in spontaneous miscarriage;
• in the uterine cavity there is a single node, the location of which is the posterior or anterior wall of the reproductive organ;
• there are no pathological changes in the uterine appendages.

Hysteroscopic myomectomy is performed on an outpatient basis and requires local or general anesthesia.

Features of the operation

This treatment involves the use of a special device - a hysteroscope, which is inserted through the woman's cervix. It is through it that a benign myometrial tumor is removed using additional surgical instruments.

Today in medical practice, treatment with hysteroscopy is carried out in the following ways:

1. The mechanical method is used if the tumor with nodes is localized under the mucous membrane of the uterine cavity and its penetration into the myometrial area does not exceed 50%. In addition, attention is paid to the size of the fibroid and it should not exceed 5 cm. Treatment mechanically significantly reduces the duration of the operation, eliminating the need for additional equipment and a special liquid medium. Reviews from specialists about this method of operation are much better than about electrosurgical surgery, which causes changes and burns to neighboring organs and tissues.
2. Electrosurgical treatment is used if submucosal nodes with a pronounced intramural component are observed. In addition, this method of surgical intervention is performed if a woman is diagnosed with benign tumors in the corners of the uterine cavity, which greatly complicates their removal mechanically.