врач, акушер-гинеколог, доктор медицинских наук
Before your surgical procedure I want to provide some information to make feel more comfortable in this unusual situation.
A hysterectomy is an operation to remove a woman's uterus. A woman may have a hysterectomy for different reasons, including:
- Uterine fibroids that cause pain, bleeding, or other problems
- Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
- Cancer of the uterus, cervix, or ovaries
- Abnormal vaginal bleeding
- Chronic pelvic pain
- Adenomyosis, or a thickening of the uterus
Hysterectomy for noncancerous reasons is usually considered only after all other treatment approaches have been tried without success
Hysterectomy is performed by different routes- vaginal. laparoscopic, abdominal
Surgeons use different approaches for hysterectomy, depending on the surgeon’s experience, the reason for the hysterectomy, and a woman's overall health
- Vaginal hysterectomy: The surgeon makes a cut in the vagina and removes the uterus through this incision. The incision is closed, leaving no visible scar.
- Laparoscopic hysterectomy: This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly or, in the case of a single site laparoscopic procedure, one small cut made in the belly button. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen. Advanced technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.
Open Surgery Hysterectomy
An abdominal hysterectomy is an open surgery.
To perform an abdominal hysterectomy, a surgeon makes a 5- to 7-inch incision, either up-and-down or side-to-side, across the belly. The surgeon then removes the uterus through this incision.
On average, a woman spends more than three days in the hospital following an abdominal hysterectomy. There is also, after healing, a visible scar at the location of the incision.
Vaginal and laparoscopic approaches(minimal invasive procedures-MIP) to remove the uterus offer a number of benefits compared to the more traditional open surgery. In general, they allow faster recovery, shorter hospital stays, less pain and scarring, and a lower chance of infection than does an abdominal hysterectomy
Not every woman is a good candidate for a minimally invasive procedure. You should talk with your doctor about whether you might be a candidate for an minimaly invasive procedures when hysterectomy is considered.
Types of Hysterectomy
Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus. Patients and health care providers sometimes use these terms inexactly, so it is important to clarify if the cervix and/or ovaries are removed:
- In a supracervial or subtotal hysterectomy, a surgeon removes only the upper part of the uterus, keeping the cervix in place.
- A total hysterectomy removes the whole uterus and cervix.
- In a radical hysterectomy, a surgeon removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of thevagina. Radical hysterectomy is generally only done when cancer is present.
The ovaries may also be removed -- a procedure called oophorectomy -- or may be left in place. Surgeon must inform patient regarding the relative risks and benefits of ovarian conservation or removal.As a consequence after ovaries removing surgical menopause is developed . With artificial menopause there is a sudden drop in hormone levels and menopausal symptoms begin abruptly. Often the symptoms experienced are more severe than those experienced with natural or premature menopause. The most common symptoms are hot flashes, Sweats, Vaginal dryness, incontinence and infections of the urinary tract ,osteoporosisThe intensity and frequency of menopausal symptoms vary from woman to woman. If symptoms are problematic, or a woman is at high risk of developing osteoporosis or heart disease, medical treatment may be recommended. Ultimately, the decision to have treatment is a very personal one and should be made by the woman only after receiving a full explanation from her doctor of the benefits and counter benefits of the various treatment options.
If ovaries are left in place, uterine tubes are removed with uterus, because,according to recent trials, 60 % of serous ovarian cancer is developing from cells of uterine tubes.
Risk of ovarian cancer is increased after 50 years age,and the only way to prevent is to perform profilactic oophorectomy.Benign ovarian cysts may also develop after ovarian preservation, and become an indication for surgical treatment.
As any surgical intervention, hysterectomy also has complications, but serious complications are very rare( 1 on 1 200 patients).Serious complications are- bowel injury( 0,3-0,4 %), bladder injury( 1-2%), ureter injury(0,5%), bleeding, infection complications(perinonitis), burns( due to using electric instruments),thrombosis, anesthesiologic complications.All complications may require reoperation, or multidisciplinar approach.
There are more complications after abdominal open surgery- wound infection, hernias formation
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