Uterine fibroids - radical surgery. Types of radical surgery for uterine myoma
A radical method of surgical treatment of uterine fibroids - a hysterectomy (removal of an organ with myomatous nodes). This surgery can be performed abdominal, laparoscopic or vaginal route. There are certain principles on which the choice of access. First and foremost, is the presence of indications and conditions for a particular method.
Abdominal hysterectomy is carried out:
Localization of tumors in the broad ligament of the uterus.
The rapid growth of the tumor because it can not exclude malignancy.
The presence of adhesions due to inflammatory changes in the pelvic organs or concomitant endometriosis.
The presence of contraindications to vaginal hysterectomy.
Suspicion of malignancy appendages.
The need for simultaneous operation of extragenital or ovariectomy, which can not be done another way.
Doubts about the purity of the processes occurring in the endometrium.
Perform a vaginal hysterectomy is possible:
Adequate mobility of the uterus.
The absence of concomitant disease of the appendages and hypertrophy of the cervix.
The size of the uterus, or not more than 12 weeks gestation, or pre-condition to reduce the size of tumors.
Availability of necessary surgical access (normal size of the vagina, the attainability of the cervix).
Indications for laparoscopic hysterectomy
The indications for laparoscopic hysterectomy are:
Endometriosis of the body of the uterus.
The rapid growth of the tumor.
Submucous fibroids, and localization of tumors with a central growth, which can not be removed by hysteroscopy.
The presence of multiple myoma nodules.
Recurrent endometrial polyps.
In the interest of the patient, if possible, perform a hysterectomy to any access, preference should be given to the vaginal method.
Depending on the amount of surgery distinguish between a total or complete (hysterectomy), partial or subtotal hysterectomy (supracervical amputation), as well as holding salpingooforektomii hysterectomy (removal of the uterus with the ovaries and fallopian tubes) and a radical hysterectomy, accompanied by resection of the upper part of vagina removal of surrounding tissue and lymph nodes.
Hysterectomy is used when it is a significant increase, the presence of ovarian disease, multiple myomas in conjunction with changes in the cervix, malignant tumors and spread of endometriosis. With an intact cervix, as well as with the express adhesive process, the conjugate with a high risk of damage nearby structures, the presence of extragenital pathology, or other causes, requiring surgery to reduce the time, she may be supravaginal hysterectomy.
A radical hysterectomy is performed in case of malignancy process. Removal of the uterus shows if they are drastically changed as a result of inflammation, endometriosis, or affected by new growth. During menopause, the appendages are removed to prevent ovarian cancer.
Now everything is done for the wider introduction in gynecological practice of organ removal operations and to the background of the severe disabling surgery as a hysterectomy.