Uterine fibroids - subtotal hysterectomy. Indications for subtotal hysterectomy for uterine myoma
Subtotal hysterectomy (supracervical amputation of the uterus) for uterine myoma performed when the patient insists on maintaining cervical pathology in the absence of vaginal and endocervical part of it.
This intervention is performed in order to shorten the operation time in patients with severe extragenital pathology in emergency situations or in the presence of pelvic endometriosis, adhesions expressed in connection with an increased risk of ureteral trauma or sigmoid colon.
Type of access may be abdominal or vaginal, the latter performed with laparoscopic-assisted or no.
The advantages of abdominal hysterectomy
The advantages of abdominal access are a great opportunity to review and revision of other abdominal organs. This is important in cases of suspected malignancy.
Indications for abdominal hysterectomy
Abdominal hysterectomy is preferable, when shown the implementation of ovariectomy is not feasible in another way, if you can not use vaginal access, availability pronounced adhesions, fibroids intraligamentarnaya, suspicion of malignancy or adnexal tumor itself with the rapid growth of extragenital, and the need for surgery. The incision for this type of hysterectomy performed in the abdomen and can be vertical, walking along the median line almost to the navel and the pubis to the level and horizontal, which is held on the bikini line.
Disadvantages of abdominal hysterectomy
The disadvantages include the presence of scar on the anterior abdominal wall, lengthening the postoperative period, accompanied by more pronounced discomfort, vaginal hysterectomy than for.
Indications for vaginal hysterectomy
Vaginal subtotal hysterectomy for uterine myoma method is carried out in the absence of concomitant disease of the appendages, sufficient mobility of the uterus, vagina prolapse, tumor size, not exceeding 12 weeks gestation and there is a sufficient surgical field.
Vaginal access incision in the vagina around the cervix, skin is left abdominal scars.
The disadvantages of vaginal hysterectomy
The disadvantage is the decrease in the area of review and space to work. When performing a vaginal hysterectomy is sometimes bringing down of the uterus is not possible. In this case, the methods used by the discharge authority husking myomatous nodes. At larger sizes perform a bilateral dissection of tumors of the cervix, providing increased access zone.
Perhaps a vaginal hysterectomy with laparoscopic-assisted. Tools, camcorder and up to pump gas into the cavity of the pelvis is administered through four small incisions (in lateral parts of abdomen at the navel and above the pubis). The uterus is removed through the vagina with the uterine manipulator. This method enables the surgeon to inspect all the organs, but it lengthens the time of surgery and anesthesia.
Subtotal hysterectomy is a reliable and relatively safe treatment for uterine fibroids, but it inevitably leads to loss of reproductive function, causing a woman not only physical but also psychological trauma.