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If you need to make a diagnosis or minimally traumatic treatment, a laparoscopy of the uterus is performed in gynecology. The choice of procedure depends on the type of disease and the severity of its course. For everything to go smoothly, the operation must be performed by an experienced specialist using proper equipment. Is it possible to do laparoscopy during menstruation and how it is performed, you will find out below.

What is uterine laparoscopy?

Laparoscopy of the uterus is a safe and gentle technique that allows not only diagnostics of the organ, but also successful operations. At the same time, in the peritoneum the surgeon does required quantity punctures Expedient this type access for neoplasms that are present in the area of ​​the organ, with anomalies of its development.

With the help of laparoscopy, endometriosis can be diagnosed, microcysts can be detected and a definitive answer can be given as to why a woman is infertile.

After this method the woman comes to her senses completely within 1-2 weeks.

In what cases is surgery performed?

The operation may be prescribed for:

• fibroids;
• fibromas;
• cysts;
• cancer;
• regular bleeding from the uterus of unknown nature;
• prolapse of the uterus and its prolapse;
• endometriosis;
• congenital defects;
• ineffective hormone therapy;
• unknown nature of infertility;
• adhesions;
• pregnancy outside the uterus.

If a woman has any of the above pathologies, it is not a fact that the doctor will opt for laparoscopy. Everything is purely individual, taking into account the patient’s age, presenting symptoms, etc.

Species

Laparoscopy can be diagnostic, operative and control.

Diagnostic

Its purpose is to confirm or refute the established diagnosis. They resort to such diagnostics in hopeless situation, when other methods could not provide answers to the questions of interest. There are cases when this type smoothly turns into operational.

Operational

Done after receiving all the tests, in the case when conservative treatment didn't help. This includes the removal of various neoplasms, both malignant and benign (fibroids, fibroids, cysts, tumors, etc.) and the removal of the organ itself.

Control

This is done to check a previous surgical intervention.

Contraindications for surgery

Before laparoscopy, the doctor must exclude all contraindications. These include:

• the presence of a hernia;
• poor blood clotting;
• exhaustion of the body;
• serious lung pathology;
• the presence of diseases that are associated with the heart and blood vessels.

If the above is not taken into account, complications may arise after the operation.

There is also a risk negative consequences after radical treatment if a woman has:

• there is obesity;
• adhesions are present;
• infectious diseases;
• there is more than 1 liter of liquid inclusions in the peritoneum.

In order for everything to go smoothly, you first need to carry out preparatory procedures or treatment (if necessary).

How to prepare for the procedure?

If laparoscopy is planned, then preparation will take a week, sometimes more. At emergency surgery a woman is cooked in a few minutes, sometimes it takes up to half an hour. The countdown goes on in seconds, because we're talking about about human life.

If there is no need for emergency surgery, the doctor gives a referral to the patient for tests:

• general (urine and blood);
• checking blood glucose;
• exclusion of STIs, HIV, hepatitis and syphilis;
• biochemical;
• determination of the Rh factor and blood group;
• A swab is taken from the vagina.

First, the doctor must familiarize yourself with the medical history and find out what the woman has allergic reactions to. Conducted gynecological examination using mirrors.

Besides laboratory research, need to go instrumental diagnostics. This is an electrocardiogram, ultrasound examination, fluorographic examination. All this is necessary for selecting an anesthetic drug and type of anesthesia.

Sometimes a woman is referred to a psychotherapist who psychological preparation. Conversations with a doctor help you come to your senses and calm down emotionally.

Is it possible to do laparoscopy during menstruation? During menstruation, surgery is usually not performed. The exception is emergency surgery when it comes to life or death. Best time– the period after critical days, in the first phase of the cycle.

If we talk about immediate preparation the day before the operation, this includes:

• refusal to eat in the evening;
• using an enema before bedtime;
• conversation with an anesthesiologist and choice of anesthesia;
• acquisition of special compression stockings or tights that will prevent blood clots (this is best done in advance).

Technique of the procedure

Laparoscopic surgery to remove the uterus or tumors in its cavity occurs through minor punctures in the peritoneum. Trocars are installed in them, which will hold the endovideo camera and other instruments that will be used during laparoscopy.

The entire area is pre-treated with an antiseptic. After punctures and insertion of instrumental equipment, the peritoneal cavity is inflated with a special harmless gas. It does not cause allergies and dissolves quickly. This is necessary for:

• increasing abdominal space;
• visualization improvements;
• freedom of action.

There can be 2, 3 or 4 punctures. It all depends on the purpose of laparoscopy. Their purpose is as follows:

1. The navel area is for a Veress needle. Gas will be supplied through it.
2. The next mini-incision is made to insert a trocar with a camera.
3. If laparoscopic removal of the uterus or any formations is performed, then a third (if absolutely necessary, a fourth) puncture is performed. The 3rd will be in the area above the pubis. A laser, scissors and other instruments are introduced there.

The monitor screen will show an image of what is happening inside. In this case, the image is enlarged several times. Laparoscopy lasts from 45 minutes to two hours. It all depends on the severity of the intervention. Diagnostic procedure It will take the least amount of time, no more than half an hour.

During the operation, the woman does not feel any discomfort or pain, since the anesthesia is general and the patient is in a medicated sleep.

Recovery period

After the operation, the woman needs a little time to recover. Since the violation of tissue integrity is insignificant, the healing process is rapid. You can get out of bed after 7-8 hours. They are discharged home after three to five days. It all depends on the woman’s condition.

At first, painkillers are prescribed to eliminate pain. Antibiotics may be prescribed to prevent infections. Proper nutrition and avoidance of physical activity are also important.

Sometimes a woman needs 10 days for everything to return to normal, while others will have to wait 20-30 days.

To recovery period has decreased, you should listen to the recommendations of a specialist, avoid visiting baths, saunas, baths. You can't exercise, have sex, or lift heavy objects.

Possible consequences and complications

Usually after this technique there are the least number of complications, but they can also occur. This:

• soreness;
• bleeding (external and internal);
• difficulty emptying the urethra.

Such consequences do not need to be treated, everything will go away on its own. Sometimes a woman may develop a fever, weakness, increasing pain and discharge from the genitals. This indicates the development of an infection. To prevent this from happening, the patient should not neglect taking antiseptic drugs and antibiotics. During laparoscopy of an ovarian cyst or removal of the uterus, symptoms may persist longer.

Is pregnancy possible after this operation?

It is possible to get pregnant after laparoscopy, but it is not advisable to rush. It is recommended to plan pregnancy after 3-6 months. Sometimes you have to wait 8-10 months. It all depends on the diagnosis individual characteristics patients. You must first consult with a gynecologist who will examine the patient, prescribe tests and some instrumental types. diagnostic examination. Only after receiving the results can something clearly be said about further actions.

If the uterus was removed using this method, pregnancy is impossible.

Cost of laparoscopy

The cost of a particular operation may vary. In each case everything is individual.

Conclusion and Conclusion

Laparoscopy of the uterus is distinguished by its gentle technique. Recovery is quick and not very painful. Operations performed on the body of the organ can not only restore reproductive function, but also extend the years of life for patients who have been diagnosed with malignant tumors. Now the question of whether it is possible to remove the uterus by laparoscopy has a clear answer.

In this way, you can determine why a woman cannot get pregnant and immediately eliminate the defect present. But, before resorting to laparoscopy, you need to undergo full diagnostics, which will eliminate all contraindications.

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For a long time it was believed that the only way To get rid of fibroids is a hysterectomy, that is, removal of the uterus. Of course, you can’t argue with this – the method is effective. However, it is completely unacceptable for young patients who have not yet fulfilled their main female mission and want to have offspring. Fortunately, for those women who, for one reason or another, need to preserve their reproductive organs, there is alternative option therapy – laparoscopy of uterine fibroids.

Today, according to leading Russian gynecologists, there is no fibroid for which a hysterectomy would be a mandatory operation. Removal of uterine fibroids laparoscopic method with preservation of the reproductive organ - this is the gold standard surgical treatment, and reviews from patients who have undergone this type of surgery are overwhelmingly positive.

What is laparoscopy?

Nowadays, medicine has reached a high technological level, making it possible to perform it without the use of a scalpel and without an incision in the anterior abdominal wall. Now, modern endoscopic equipment is used for this - a device in the form of a flexible tube equipped with a lens system and a video camera, called a laparoscope.

Laparoscopy is performed using endoscopic equipment (monitor, light) and accompanying surgical instruments.

For reference

Translated from Greek language“lapara” – belly, “scopeo” – look, see. Thus, the main difference between this method and the classical surgery Its name itself says it all – “laparoscopy”. During such a procedure, the surgeon, without exposing the internal organs or touching them with his hands, can see them using a camera and even perform an operation.

Laparoscopy is divided into diagnostic and therapeutic. Diagnostic laparoscopy allows you to conduct an examination without making large incisions on the patient’s body. internal organs, obtain information about their condition and deliver correct diagnosis. Therapeutic laparoscopy involves surgical removal of the detected pathology.

Today, gynecologists can remove uterine fibroids without looking directly into the surgical wound. Using laparoscopic access, it is possible to remove even, looking only at the screen, while preserving the uterus and giving the patient a chance for happy motherhood.

With laparoscopy, the doctor can remove the tumor while looking only at the monitor screen.

Myomectomy is surgical removal single or with preservation of the uterus. This operation is performed on women who wish to have children in the future after it is performed. The intervention is most effective for interstitial fibroids, as well as for nodes that grow outside the uterus (subserous, pedunculated). In this case, no significant damage to the uterine muscle occurs. This type of operation is called conservative, and it can be performed in two ways: laparoscopic and by laparotomy.

is a surgical intervention with minimal trauma, in which the anterior abdominal wall Three small punctures 5-10 mm long are made, through which the tumor is removed using special instruments, while the uterus is preserved. Subsequently, a woman can plan a pregnancy, bear and give birth to a child.

The goal of laparoscopic surgery is to gently remove the myomatous tumor, while preserving the menstrual cycle and the woman’s ability to bear children.

Carrying out such a manipulation requires the highest professionalism and skill from the surgeon: without touching the organ with his hands, the doctor must reliably suture the muscle after removing the node so that during subsequent pregnancy and childbirth the uterus does not rupture in this place. can be found in a separate article.

Laparoscopy can only be performed by highly qualified specialists.

Laparoscopic surgery is performed to remove fibroids in large medical centers, and the cost of such intervention is sometimes considerable. As a rule, prices depend on the category and status of the medical institution, on the qualifications of the operating surgeon, as well as on the quality of the endoscopic equipment used. The price range for this service in the Russian Federation is from 35 thousand rubles in large regional centers to 100 thousand rubles in elite clinics in Moscow.

Free removal of fibroids by laparoscopy is also possible. This operation is performed in public clinics that have endoscopic equipment and have highly qualified specialists, subject to quotas for the provision of high-tech assistance from federal budget funds.

Advantages of laparoscopic surgery

Before the introduction of laparoscopic equipment into gynecological practice, doctors could also save the uterus by removing only fibroid nodes. But at the same time, it was performed, that is, an incision of about 15 cm in length was made with a scalpel in the anterior abdominal wall, through which the tumor was removed. After such an operation, a scar remained on the skin of the abdomen, which caused a lot of grief to representatives of the fair half of humanity.

Needless to say, such incisions caused women not only cosmetic troubles, but also took a very long time to heal after surgery, and also caused long-term rehabilitation for patients.

The laparotomy operation, in which an incision is made in the anterior abdominal wall, is quite painful during the rehabilitation period and is often associated with various complications, including bleeding and inflammatory processes.

So, the main advantages of the laparoscopic technique, compared with laparotomy, are:

• Cosmetics – post-operative scars are almost invisible;
• Less surgical trauma;
• Bloodless procedure or minimal blood loss;
• No need for a long hospital stay;
• Quick recovery and return to an active lifestyle;
• Reducing postoperative pain;
• Improving the quality of life of patients;
• Volume reduction drug therapy in the postoperative period;
• Less risk of adhesions.

Indications for laparoscopy

Conservative myomectomy is performed laparoscopically in the following cases:

• Uterine fibroids up to 12-15 weeks in size in women of childbearing age;
• When uterine fibroids are the only cause of infertility and (or) miscarriage;
• Severe anemia in a woman due to uterine bleeding, the cause of which is uterine fibroids;
• Severe pain arising from malnutrition of the node;
• Rapid tumor growth;
• Violation normal operation organs adjacent to the uterus (ureters, bladder and intestines).

The laparoscopic method of fibroid removal is used, among other things, for rapid growth neoplasms.

Contraindications

Laparoscopic surgery is contraindicated under the following circumstances:

• The patient has diseases for which surgical intervention may create real threat for her life (pathology of the heart and blood vessels, decompensated respiratory failure, liver failure, bleeding disorders, diabetes mellitus);
• Oncological pathology of the genital area cannot be excluded;
• Dimensions of myomatous nodes after hormonal treatment at the stage preoperative preparation remain more than 10 cm and there is no tendency to reduce them. we discussed in another article;
• It is known that removal of multiple nodes will not restore the reproductive function of the uterus and the desired pregnancy will not occur;
• Acute inflammatory processes in the abdominal cavity, acute respiratory viral infections or exacerbation of chronic diseases;
• Period of menstruation;
• Uterine pregnancy (if there are no strict indications for surgical treatment);
• The patient is severely malnourished;
• There are hernias in the abdominal area.

Obesity and severe adhesions in the abdominal cavity can also serve as a limitation to surgery.

With progressive adhesive disease, there is a limitation on laparoscopic myomectomy. The picture shows the degrees adhesive process: I - limited to area postoperative scar; II - localized in combination with single spikes in other places; III - adhesions occupy 1/3 of the abdominal cavity; IV - occupy most of the abdominal cavity.

It is believed that laparoscopic myomectomy is most effective when there are no more than 4 myomatous nodes on the uterus and when the size of the organ is up to 12 weeks. In all other cases, preference should be given to laparotomy access. At the same time, it should be noted that with the advent of high-tech morcellators in practice, it became possible to perform laparoscopic operations for fibroids up to 15-16 weeks in size. can be found in our article.

In addition, with multiple nodes there is high probability recurrence of the disease (more than 30%), while with single formations relapse occurs only in 10-20% of cases.

How to prepare for surgery

As with any other elective operation, it is necessary to undergo an examination, which includes:

• Blood tests - clinical, biochemical, identification of coagulation system indicators, examination for hepatitis B and C, HIV infection and syphilis, as well as determination of blood group and Rh factor;
• General urine analysis;
• Gynecological ultrasound;
• Smear to determine vaginal microflora and cytological examination;
• Fluorography;
• Dentist's conclusion about the absence of caries;
• The therapist’s conclusion about the absence of chronic diseases, the course of which may worsen during the operation;
• Consultation with a doctor who will administer anesthesia.

Among the examinations that must be completed in preparation for laparoscopic myomectomy are a smear for flora and cytology.

Preparation for laparoscopic tumor removal includes the following points:

• A few days before surgery, exclude foods that cause increased gas formation;
• On the eve of the procedure, a light dinner is allowed no later than 18:00;
• In the evening and morning, intestinal cleansing is carried out;
• On the day of surgery, food and liquid intake is prohibited.

To prevent thromboembolic complications, elastic bandaging is necessary before surgery. lower limbs or use compression hosiery(anti-varicose stockings).

How the operation is performed

Removal of uterine fibroids using the laparoscopic method is always carried out in a gynecological clinic or hospital in a sterile operating room.

Elective surgery is usually performed in the morning or early afternoon and lasts from 30 minutes to two hours, depending on the scope of the operation and the size of the tumor.

Any day of the cycle is suitable for laparoscopic manipulation, except for the period of menstruation. During menstruation it is noted increased bleeding, therefore, the risk of bleeding during surgical procedures increases.

Anesthesia - endotracheal with the use of mechanical ventilation. The patient is asleep, does not hear, see or experience anything pain.

Before the operation begins, combined anesthesia is used - endotracheal anesthesia, which helps to endure the entire surgical process without pain and stress.

Before the operation, the woman signs an informed consent, thereby confirming that the doctor explained to her how the fibroids will be removed and the possible change in the scope of the operation if complications arise. In the event of an unforeseen development of events, the surgical intervention may end, which the doctor also warns about before the operation.

What happens in the operating room

• The patient is placed on the operating table. After treating the abdominal skin, the surgical field is covered with sterile sheets;
• After the anesthesia has taken effect, at the navel and on the sides of the abdomen in iliac regions punctures are made through which endoscopic instruments are inserted;
• For better review uterus, carbon dioxide is introduced into the abdominal cavity, which is completely harmless to the body. The intestinal loops move from the pelvis to the upper abdomen and do not create an obstacle to the operation;
• The surgeon examines the uterus, appendages, and fibroid nodes. An image of what is happening in the patient’s abdominal cavity is transmitted to the monitor screen. During the operation, the doctor does not touch the pelvic organs with his hands.

Operation stages

• Cutting off a fibroid node (if it has a stalk) or enucleating a tumor located in the muscular wall of the uterus. To do this, an incision is made on the surface of the capsule, the knot is fixed with two clamps and removed by successive pulling. Myomatous nodes are characterized by the presence of a clearly defined capsule, due to which they are easily removed without additional trauma to the uterine wall. The tumor bed (the place where it was located) is washed saline solution, and then carefully coagulate the bleeding areas;

The process of myomectomy begins with cutting off or enucleating the tumor.

• Suturing a defect in the muscular wall of the uterus. The myometrial defect formed after tumor removal must be sutured. The surgeon also performs this manipulation without touching the organ with his hands, but only by looking at the screen and using instruments inserted into the woman’s abdominal cavity. Applying an endoscopic suture is the most time-consuming and labor-intensive stage of the operation. The suture must be reliable so that there is no threat of uterine rupture in this place in subsequent births. This requires some experience on the part of the surgeon;
• Removal of fibroids from the abdominal cavity. Small myomatous nodes can be easily removed through existing incisions in the abdominal wall. To extract large nodes, you will need to use a special tool - an electric morcellator, which, using a system of rotating knives, first crushes and then “sucks” parts of the tumor into itself, like a vacuum cleaner. In this way, large fibroid nodes are removed;
• Inspection and sanitation of the abdominal cavity is the final stage. At the end of the operation, the surgeon once again examines the abdominal cavity, removes accumulated blood clots, checks the integrity of the sutures on the uterus, performs hemostasis of small bleeding vessels and removes instruments. The total volume of blood loss during surgery is no more than 50 ml;
• To prevent the formation of adhesions, a special anti-adhesive mesh is used, which dissolves after 14 days and does not allow the intestines or omentum to be soldered to the postoperative scar;
• Intradermal injections are applied to the puncture site. cosmetic stitches, which resolve on their own within 2-3 months and subsequently become pale and unnoticeable;

After laparoscopy, the punctures are sutured subcutaneously, and cosmetic stitches are applied to the skin.

The progress of the laparoscopic operation is recorded on video, and each patient has a video protocol.

Postoperative period

Compared with abdominal surgery, myomectomy performed by laparoscopic access has a more favorable postoperative course:

• Patients are activated early, which is the prevention of thromboembolic complications;
• Due to the low invasiveness of laparoscopy, the pain syndrome is mild, which means that narcotic painkillers are not required;
• Antibacterial and anti-inflammatory therapy is indicated only for those women who have a high risk of infectious complications;
• If thrombosis is likely to develop, anticoagulants (drugs that prevent blood clots) are prescribed, and elastic leg bandaging or wearing compression stockings for at least two weeks is recommended.

Note

After laparoscopic removal of uterine fibroids, patients can get up, walk, serve themselves, drink and eat light liquid food on the day of myomectomy after 3-6 hours. Strictly comply bed rest on the first day after surgery is not required.

After laparoscopic myomectomy, a woman, in agreement with the attending physician, can take care of herself even on the first day after the operation.

Possible complications

Complications after laparoscopy are quite rare. But, as with any other surgical operation, they are possible. These may include:

• Unsuccessful introduction of gas into the abdominal cavity, which causes subcutaneous emphysema (on palpation, a characteristic crunch is detected in the subcutaneous fat layer);
• Puncture of the intestine with a needle while filling the abdominal cavity with gas. To avoid this, it is very important to have a good bowel movement before surgery;
• Injury to organs (ureter, bladder) and large vessels;
• Bleeding from the bed of myomatous nodes;
• Formation of hematomas in the wall of the uterus;
• Infectious complications in the early postoperative period.

Rehabilitation period

After laparoscopy of uterine fibroids, the woman recovers very quickly and returns to her normal lifestyle. If the course is favorable postoperative period the woman is discharged from the hospital home on the 2-3rd day after surgery. In case of complications, which are rare, there is a need for a hospital stay of up to 7 days.

Sick leave is usually issued for 7-14 days. If a woman’s work does not involve heavy physical labor, she can begin her duties, if desired, on the 4th day after the operation. The temporary disability certificate can be extended if necessary (for example, if complications arise or if general health is unsatisfactory).

Full restoration of working capacity occurs in 15-30 days.

Menstruation after surgery usually begins within 28-30 days, but their delay is not a reason to panic. This may be due to previous surgery. Surgery is stressful for the body and can cause problems menstrual function. Intermenstrual discharge is also acceptable.

After surgery, possible intermenstrual bleeding is considered normal.

Physiotherapy during the rehabilitation period is not a mandatory procedure and is prescribed at the discretion of the doctor to prevent adhesions or inflammation.

For six months after the operation, the woman is under dynamic observation by a gynecologist. She should return for examination and ultrasound 1, 3 and 6 months after fibroid laparoscopy.

Until the scars on the uterus are completely healed (and this will take 3-6 months), it is prescribed hormonal contraception. The choice of the appropriate drug is made by the doctor depending on the condition reproductive system women.

6 months after the follow-up examination and ultrasound, when the doctor is confident that the uterine scar is intact, the patient is allowed to plan a pregnancy.

Important to know

After laparoscopic myomectomy, childbirth is possible both through the natural birth canal and caesarean section. The method of delivery is determined by the doctor based on obstetric indications.

During the rehabilitation period for 1 month it is recommended:

• Wear a bandage to reduce the load on the anterior abdominal wall;
• Limit heavy lifting and physical activity;
• Abstain from sexual intercourse;
• Follow a diet and organize proper nutrition - exclude from the diet fatty foods, products, causing bloating stomach and increased gas formation (legumes, fresh vegetables and fruits) as they can cause stomach pain and diarrhea;
• Postpone sports activities for up to 4-6 months to ensure complete healing of the uterine scar.

To reduce the load on the abdominal wall during the rehabilitation period, it is advisable to wear a postoperative bandage.

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Uterine fibroids are a disease for which doctors perform laparoscopic surgery. The specialists with whom we cooperate use new method treatment of uterine fibroids - embolization of the uterine arteries. During the procedure, the endovascular surgeon injects an embolic agent into the arteries of the uterus through a puncture. femoral artery. After this, the blood supply to the myomatous nodes stops, and they decrease in size.

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

If you have been diagnosed with uterine fibroids, do not be nervous. Call. Our specialists organize treatment in the best gynecological clinics. They will be constantly in touch with you. You have the opportunity to get

On days 2-5 after laparoscopy of uterine fibroids, the woman is discharged from the hospital. In order for the postoperative period to proceed without complications, she must follow the doctor’s recommendations. They depend on the volume of surgical intervention.

Women often ask what to do after laparoscopy and what procedures can cause complications. Before the operation, the doctor tells you how the surgical intervention will take place, how it differs from abdominal surgery, how to prepare for laparoscopy and behave during the rehabilitation period.

The main advantage of laparoscopy is that during the operation the surgeon does not make a large incision in the anterior abdominal wall. During laparoscopy, blood loss is negligible. After completing the main stage of the operation, the doctor removes the instruments from the abdominal cavity, applies 1-2 silk sutures and an aseptic gauze bandage to the incisions. They are removed 5-7 days after laparoscopy. After embolization of the uterine arteries, no sutures are applied.

After discharge from the hospital, the patient must change the bandage daily and lubricate the puncture sites with a 1% solution of iodine or brilliant green. Until the wound has completely healed, a woman is not recommended to take a bath. While showering, she should cover the puncture sites with a waterproof cloth to prevent water from getting on the bandage. For three months After laparoscopy, it is contraindicated to visit the sauna and bathhouse, or take thermal procedures.

Women are interested in what they should do after laparoscopy to speed up their recovery. Laparoscopy is a surgical procedure. During the first 5-7 days after surgery, it is necessary to maintain semi-bed rest, but you should not spend much time in bed. Useful walks on fresh air at a slow pace.

There are restrictions on lifting weights after laparoscopy. During the first three months after surgery, a woman should not lift a load weighing more than 3 kg. Then for the next 3 years she can lift no more than 10 kg. After embolization of the uterine arteries there are no restrictions on the regimen.

Diet after laparoscopy

After laparoscopy, a woman needs to follow a diet. She is allowed to eat on the second day after the operation. Food should be taken in small portions, 5-6 times a day. The patient’s diet after laparoscopy should not contain the following foods:

• spicy, fatty and fried foods cooked with a large amount of vegetable or butter;
• fats of animal origin.
• smoked, pickled and canned food products.

Doctors prohibit eating lard and fatty meats after laparoscopy. Sweets and canned goods should be avoided. They can cause increased gas formation and bloating. From the menu it is necessary to exclude dishes from beans, which cause digestion, causing bloating and flatulence.

For 30 days after laparoscopy, a woman is not allowed to drink alcohol. If a woman smokes, she should give up this habit for 3-4 weeks. A healthy lifestyle promotes rapid tissue healing after laparoscopy.

The basis daily diet after laparoscopy should be made of non-rich broths, vegetable soups, pore and cereals, fresh fruits and vegetables, whole grain bread, dairy products. Food should be simple, steamed, in the oven. It is better to boil vegetables, cook in a double boiler or stew. The patient's diet after laparoscopy should contain sufficient amounts of protein, vitamins and minerals.

Planning pregnancy after laparoscopy

It is necessary to plan a pregnancy after laparoscopy together with your doctor. M This depends on the diagnosis for which surgery was performed. If a laparoscopic myomectomy was performed (removal of myomatous nodes while preserving the uterus), the reproductive organ needs time for sufficient scars to form. If pregnancy occurs earlier, uterine rupture may occur during childbirth. After embolization of the uterine arteries, scars do not form on the uterus, pregnancy and childbirth proceed without complications.

Pregnancy can be planned no earlier than 12 months after laparoscopy for fibroids. During this period of time, the woman should take oral contraceptives. After embolization of the uterine arteries, pregnancy is planned after 6 months.

In the case where laparoscopy was performed for adhesive disease, doctors recommend planning pregnancy no earlier than 3 months after the operation. After dissection of adhesions and laparoscopy fallopian tubes It takes time for the swelling of the fallopian tubes to go away. The swelling subsides within one month, but the woman’s body must recover after the operation. The probability of successful conception is higher the less time has passed after the dissection of adhesions, but against the background of swollen fallopian tubes, the likelihood of an ectopic pregnancy is high. For three months after laparoscopy, the patient takes monophasic oral contraceptives. These medications prevent untimely stress of pregnancy and provide an opportunity for the ovaries to rest. After discontinuation of the drugs, the ovaries will begin to function in an enhanced mode.

You should not rush into pregnancy even after laparoscopy for an ovarian cyst. Removal of the cyst during laparoscopy is carried out carefully, only the formation is removed, leaving healthy tissue. It takes 1 month to restore the ovaries after laparoscopy, but doctors recommend planning a pregnancy no earlier than 6 months after the operation. During this time, the woman takes monophasic contraceptives. They protect against unplanned conception, normalize hormonal background and allow the ovaries to rest. If pregnancy is not planned, complications can be expected. A woman should immediately visit a gynecologist and register.

Laparoscopy is performed for polycystic ovary syndrome. This is a disease that is characterized by the presence of cystic formations on the surface of the uterine appendages. During laparoscopy, doctors can perform the following surgical interventions:

• cauterization (multiple incisions are made on the ovarian capsule);
• wedge resection (excise part of the ovary along with the capsule);
• decortication (remove part of the compacted capsule).

After such operations, the ability to conceive is restored for a maximum of one year. Therefore, doctors recommend using contraception for 6 months and then planning a pregnancy.

Regardless of whether during laparoscopy for an ectopic pregnancy a tubectomy is performed or the fertilized egg is removed from the fallopian tube with its preservation, doctors recommend that the woman take contraception for 6 months after the operation. This period of time is necessary for hormonal levels to be restored.

During laparoscopy for endometriosis, surgeons either remove the endometrioid cyst or cauterize the endometrioid lesions on the surfaces of the organs and peritoneum, while simultaneously cutting the adhesions. Pregnancy has a beneficial effect on the course of endometriosis, but it should be planned no earlier than 3 months after surgery. The patient is often prescribed hormonal drugs to prevent relapse of the disease. In this case, pregnancy can be planned after completing the course of hormone therapy.

Menstrual cycle after laparoscopy

After laparoscopy, in most cases, the first menstruation occurs on time. This is evidence normal functioning ovaries. Your period may be delayed for several days or 2-3 weeks.

If the delay is longer, the woman should consult a gynecologist. After the operation, moderate mucous or spotting. This is considered normal if surgery was performed on the ovaries. Sometimes bloody discharge persists for three weeks and progress to menstruation.

In the first days after laparoscopy for ectopic pregnancy, moderate or slight bleeding appears. They are associated with the rejection of the inner lining of the uterus, to which the embryo should have attached, but did not attach. This is absolutely normal.

Preparing for pregnancy after laparoscopy

You should plan a pregnancy after laparoscopy together with your doctor. This will increase the chances of successful conception and reduce risk possible complications pregnancy. A woman needs to visit a gynecologist and undergo an examination:

• general clinical blood and urine tests;
• biochemical blood test;
• determination of blood glucose levels;
• tests PCR method for sexually transmitted infections;
• smears from the urethra, vagina and cervix;
• determination of the concentration and ratio of hormones.

Everyone married couples You should undergo genetic counseling. If necessary, the doctor prescribes colposcopy for women planning pregnancy, ultrasound examination pelvic organs or mammary glands.

• take folic acid at least 3 months before planned pregnancy;
• give up bad habits;
• lead active image life (walk in the fresh air, swim, ride a bike;
• organize proper healthy nutrition;
• avoid stressful situations;
• determine or calculate the days of ovulation and be “active” during this period.

The course of pregnancy and childbirth after laparoscopy

If the patient follows the doctor’s recommendations, pregnancy after laparoscopy proceeds without complications. Possible deviations from the normal course of the gestation period may arise not because the woman underwent laparoscopy, but in connection with an existing disease. If pregnancy occurs earlier than 3 months after ovarian laparoscopy, there is a risk of miscarriage early stages due to a failure of the hormone-forming function. To prevent miscarriage, the doctor prescribes progesterone and drugs that have an antispasmodic effect to the patient.

After laparoscopy, other complications of gestation may develop:

• intrauterine infection;
• polyhydramnios;
• fetoplacental insufficiency;
• placenta previa, incorrect position and fetal presentation (after removal of myomatous nodes).

In most cases, laparoscopy is not a contraindication for vaginal delivery. The exception is surgery on the uterus (reconstruction of the uterus for developmental abnormalities or removal of fibroid nodes). After them, scars remain on the uterus. They create rupture of the reproductive organ during childbirth. In this case, obstetricians prefer to perform a caesarean section. After embolization of the uterine arteries, pregnancy proceeds normally, the woman gives birth on her own.

After laparoscopy, an anomaly of labor may develop, early postpartum hemorrhage, postpartum involution of the uterus. These complications are associated with the pathology for which laparoscopy was performed. In women for whom our doctors performed uterine artery embolization, childbirth and postpartum period proceed normally.

References

• 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 of Medical Literature, 2010. - 368 p.
• Braude, I. L. Operative gynecology / I. L. Braude. - M.: State Publishing House of Medical Literature, 2008. - 728 p.

Laparoscopy of the uterus is a modern minimally invasive method of surgical intervention, which is performed through several punctures in the abdominal cavity. Laparoscopic hysterectomy is rarely performed. In most cases, this is the method used to diagnose and treat benign and malignant neoplasms in the tissues of the uterus. Laparoscopy can be prescribed to eliminate structural defects of the organ, as well as for treatment various diseases gynecological nature, in particular fibroids.

Advantages of the laparoscopic method

Unlike traditional surgery, laparoscopy is valued because during its implementation there is no significant damage to soft tissues, and the degree of blood loss is low. In addition, the recovery period and pain intensity after such surgery are significantly lower than after classical operation, which implies direct access to the woman’s reproductive organs through a significant incision in the abdominal wall.

Laparoscopy of fibroids has the most important advantage - it allows you to save a woman’s uterus. This method of treatment is especially relevant for girls who are just planning motherhood. In addition, after this method of treatment, the likelihood of relapse of the pathology is significantly reduced.

After laparoscopy, the rehabilitation period is significantly reduced. Of course, a lot depends on the complexity of the pathology being treated, but even if the uterus was removed, the patient can be discharged from the hospital in approximately 1-1.5 weeks.

Another advantage that this method of diagnosing and treating the organs of the reproductive system has is the absence of large and unsightly stitches, which are characteristic of other methods of surgical intervention. Laparoscopic intervention minimizes the risks of thromboembolism and postoperative pneumonia.

Preparing for surgery

Any surgical intervention should be as safe as possible, therefore, after laparoscopy has been prescribed, the woman will have to properly prepare for it.

In addition to analyzes that characterize general condition patients are prescribed additional methods examinations that allow you to collect all the data about the characteristics of the female body.

In the presence of an inflammatory process, as a rule, surgery is postponed until recovery. The exception is cases when there is an urgent need for surgical intervention, for example the threat of an abscess.

If a woman has problems with blood clotting, then before surgery she needs to undergo an appropriate course of treatment that will avoid bleeding and the formation of blood clots.

A prerequisite for preparatory measures is taking a blood test to clarify its group and Rh factor. The received data is entered not only into the outpatient card, but also into one of the documents, which is an identity card.

Due to the fact that laparoscopy is painful procedure which is carried out under general anesthesia, a test is first done that determines the body’s response to medicine, which will be used to immerse the patient in anesthesia. The drug is selected taking into account the absence allergic reaction.

Laparoscopy can be performed on any day of the menstrual cycle. The only prohibition is considered to be directly critical days.

Regardless of the purpose for which laparoscopy is performed, the woman is immersed in anesthesia, and then several holes are made in the abdominal wall. Through them you enter all the necessary medical instruments, camera and light. To improve video quality, the abdominal cavity is filled with carbon dioxide. If necessary, an additional uterine probe can be inserted (through the vagina).

In case of uterine fibroids, the laparoscopic method of removing the pathogenic node allows the procedure to be performed without injuring the woman’s reproductive organ itself, which automatically preserves its normal functions.

Laparoscopy is often prescribed for women diagnosed with uterine prolapse. Through punctures in the abdomen, the doctor stitches and strengthens the ligaments that support the uterus in the correct position.

IN lately Laparoscopy has become increasingly used to remove tumors and metastases.

If there is a need to remove the reproductive organs, during laparoscopy the doctor assesses their condition and decides which part of the reproductive organs will need to be removed.

There are several types of hysterectomy:

• subtotal;
• total;
• hysterosalpingo-oophorectomy;
• radical.

Removal of the uterus without ovaries is quite easily tolerated by a woman. In some countries, women who do not plan to give birth and who are over 50 years of age agree to a procedure such as subtotal hysterectomy, without the presence of any pathological process. After removal of the uterus, a woman completely misses her period and becomes infertile. But due to the fact that the ovaries remain and continue to function normally and produce hormones necessary for the body, the woman feels good. In the absence of a uterus, menopause does not occur prematurely.

With a total hysterectomy, which is prescribed to women when diagnosing malignant neoplasms, the uterus and its cervix are removed using laparoscopy. An indication for the procedure may be internal endometriosis, which causes frequent and heavy bleeding, which poses a danger to the patient’s life.

Hysterosalpingo-oophorectomy is complete removal all female reproductive organs (uterus, tubes and ovaries). The operation may be prescribed due to the occurrence of a bilateral purulent-inflammatory process occurring in the ovaries. In case of uterine cancer, removal of other reproductive organs may be necessary due to the proximity of the pathology site to other (healthy) tissues.

Radical hysterectomy involves removing not only the body and cervix, ovaries and fallopian tubes, but also the upper part of the vagina, the nearest lymph nodes and parts of the fiber that surrounds a woman's reproductive organs. This method of removal is recommended if there is a risk of spread cancer cells to other pelvic organs.

Complications after laparoscopy

Both during surgery and in the postoperative period, there is always a risk of complications. But for laparoscopy, this percentage of probability is much lower, in contrast to classical surgery, and is approximately 2-3%.

What you should be prepared for:

1. Damage to internal organs. During the insertion of instruments into a woman’s body, mechanical trauma to tissue may occur. Trauma can also occur as carbon dioxide fills the abdominal cavity.
2. Damage to large vessels. If during the puncture or during the operation itself the large vessels, may open heavy bleeding with the subsequent need for donor blood transfusion.
3. Subcutaneous emphysema. It occurs as a result of carbon dioxide entering the subcutaneous fat. As a rule, it goes away on its own within a couple of days.
4. Mechanical damage to internal organs. As a rule, such a complication occurs due to insufficient medical qualifications.
5. Attachment of infection. IN postoperative wound infection may occur. For this reason, immediately after laparoscopy, a woman is prescribed a course of antibiotics.

If the operation was successful and there are no complications in the postoperative period, the woman is prescribed a special rehabilitation course. It is selected for each patient individually. Great value on the road to recovery has nutrition. You need to give up fried, fatty, smoked, salty and sweets. The basis of the patient’s daily menu should be: fresh vegetables, berries, bran bread, fruits, buckwheat, rice and oatmeal. It is recommended to follow the diet for at least 3 weeks.

It is especially important for a woman to take care of her health if she wants to live a long and happy life, and also give it to your children. When the first alarming symptoms appear, indicating problems in the body, you should immediately contact a specialist. IN best case scenario you can get away with just a course of vitamins, and at worst, chronic inflammatory processes can lead to disruptions in endocrine system, hormonal imbalance and hysterectomy surgery. The last procedure will be discussed in the article. We will tell you what pathologies can lead to amputation of the reproductive organ and how the removal occurs.

What is the uterus and what function does it perform?

The uterus is reproductive organ V female body, which is responsible for procreation. In its structure, the organ resembles a small bag, which is covered with elastic muscles. Typically, the main function of the uterus is to carry the fetus from conception to birth. Just like other organs, the pyriform hollow body is nourished by blood vessels. Despite popular belief, the organ is not responsible for the production of hormones, such as the ovaries, thyroid gland and pituitary gland, but is important for those who want to bear a healthy baby.

Note. The uterus is a capricious organ that can easily become dislodged if the body is subjected to excessive stress. It is for this reason that a woman is not recommended to lift weights of more than 2 kg in one hand. There are also pathologies (defects) of this organ, for example prolapse, prolapse or duplication.

Why can the uterus be amputated?

It should be noted that surgery to remove the uterus is prescribed only by a surgeon and strictly after a complete examination.

Main reasons for deletion:

1. Benign/malignant fibroids. In this case, the organ can be amputated only for medical reasons. The number of fibroids on muscle tissue, their size, and diameter are taken into account. Also, when a woman detects fibroids, she must undergo histology tests. There are cases when fibroids are benign and can be removed without damaging the reproductive organ. This helps women under 50 to bear children without harming their health. By the way, in women over 50 years of age, uterine fibroids can lead to the development of cancer.
2. Oncology of female genital organs. If metastases have spread to the ovaries or cervix, amputation of the organ is often prescribed.
3. Descent or prolapse of the hollow body. There are 4 degrees of pathology. If a woman is diagnosed with 3rd or 4th degree prolapse, the uterus may be removed.
4. Organ rupture during childbirth or pregnancy.
5. Heavy bleeding, especially during the postpartum period.

Laparoscopy of the uterus: what is it?

Removing the uterus using the laparoscopic method avoids the formation of large scars on a woman’s abdomen. This is one of the most effective procedures, thanks to which the risks of both bleeding during amputation and complications in the postoperative period are reduced.

In medicine, laparoscopy is not only the removal of organs with minimal risks, but also a universal diagnostic method. To carry out the procedure, manipulators or instruments are used that allow one to assess the condition of the internal organs through the smallest cut. If surgical intervention is required during diagnosis, the surgeon makes several punctures through the abdominal cavity.

The main feature of the procedure is the use of special tools. They are equipped with microscopic cameras and lighting, which allows the specialist to perform complex operations without opening the abdominal cavity. Removal of the uterus using the laparoscopic method does not injure muscle tissue, which prevents the formation of hernias, adhesions and ruptures. The procedure is not performed without anesthesia because the woman can feel her stomach being inflated and the incisions made, even if they are minimal.

How is hysterectomy performed using laparoscopy?

Removal of the uterus using the laparoscopic method takes place in several stages.

1. Preparing the patient for amputation. As a rule, within a few days the woman is prescribed special diet and solution for complete cleansing intestines. On the day of surgery, the patient is given an enema twice a day, and an ultrasound is performed to confirm readiness for surgery.
2. Anesthesia and start of surgery. Amputation is performed either under local anesthesia or general anesthesia. After the woman's body is ready for the procedure, the surgeon carefully makes several incisions into which cameras, lighting, and amputation instruments are inserted. Immediately after anesthesia, gas is injected into the abdominal cavity, which expands the abdominal walls. This allows for a preliminary diagnosis of the pelvic organs and the start of surgery.
3. Removal of the uterus. The surgeon and his assistants monitor the progress of the operation through a monitor, which displays images from one of the cameras inserted into the abdominal cavity.
4. Cleaning the abdominal cavity. After amputation, it is necessary to check whether all vessels are closed and there is no bleeding. During completion, any remaining blood is removed and all instruments are removed from the cavity. It should be noted that all stitches after removal of the uterus are cosmetic and neat.

Cost of laparoscopy

Nowadays, laparoscopic hysterectomy is one of the most popular surgical procedures. All due to minimal risks, barely noticeable stitches and careful removal without damaging adjacent abdominal tissues. Let's look at the cost of laparoscopic surgery to remove the uterus, both in Russia and in other CIS and European countries.

• Russia. Average cost procedures with all accompanying tests range from 90,000 to 120,000 rubles. The reputation of the clinics must also be taken into account. For example, if there is only one clinic in the region where high-quality laparoscopy of the uterus is performed, then the cost can vary from 90,000 to 150,000 rubles. At the same time, for non-residents, the provision of a bed during the rehabilitation period can amount to an additional 30,000-60,000 rubles.
• Germany. On average, the total price tag can reach 8,000-10,000 euros. The price includes flights, accommodation, and full examination the best specialists, as well as rehabilitation and observation in the postoperative period. For residents of the CIS countries, the amount can reach 800,000 rubles.
• Israel. Despite the fact that Israel has some of the most competent and qualified specialists in the world, the cost of the procedure can reach only 400,000 rubles.

Why such a cost? Because the laparoscopic method is a virtually bloodless operation that requires the use of the best skills and specialized instruments. At the same time, the time of the procedure does not affect the cost. Laparoscopy of the uterus can take place within 15 minutes or over several hours.

Postoperative period

The laparoscopic method is unique in that a woman recovers in literally 3-7 days. Immediately after the procedure, the woman is brought to her senses to check all reflexes. If her condition is satisfactory, she is transferred to the general ward. As a rule, for recovery the patient is prescribed a special diet consisting of liquid and non-roughage food. This is necessary in order to injure the walls of the abdominal cavity as little as possible.

If a woman does not follow a diet, then the intestines may form feces and gases, which, when expanded, will put pressure on internal organs and cause pain. That is why the patient should monitor her diet and consume as much fiber as possible to improve intestinal motility.

The postoperative period after removal of the uterus using the laparoscopic method involves additional diagnostics. In the first six months, a woman should be observed by a specialist at least twice to avoid complications and discharge.

Why does pain occur after uterine amputation?

The risk of complications after organ removal is minimal, but the first alarming symptom for a woman may be pain. First of all, the patient should pay attention to the location of the pain and its nature, and also immediately contact a specialist for diagnosis.

The main cause of pain is damage to soft tissues. Despite the fact that laparoscopy is performed without opening the abdominal cavity and removing internal organs, the procedure still involves amputation of the uterus. Tissue damage occurs in any case. Even the most qualified surgeon cannot avoid this, because the uterus has a complex muscular structure. The first pain may appear after a few hours, when the effects of anesthesia and painkillers finally wear off. By nature it is weakly expressed, aching and long-lasting.

Another reason for the appearance unpleasant pain- This is nitrous oxide or carbon dioxide, which is used during the procedure to expand the boundaries of the abdomen.

Pain after hysterectomy can occur from excessive exercise or poor diet. As mentioned above, if a woman in the postoperative period abuses salty, spicy and smoked food, drink alcohol and carbonated drinks, then intestinal motility will be disrupted, which can cause constipation, which will put pressure on injured tissues.

What to do if discharge appears after removal

If discharge appears after removal of the uterus using the laparoscopic method, then in no case should you panic. During the postoperative period, discharge is a completely natural phenomenon, especially if it does not have a purulent odor and consists of a translucent liquid. This is an indicator that the process of restoration of damaged tissue is occurring. Let's take a look normal discharge and those that should cause anxiety in the patient.

• Norm. During the rehabilitation process after removal of the uterus using the laparoscopic method, the discharge should be light and transparent. Blood may be observed. If there are no complications, then discharge appears within 3-4 weeks after amputation. At the same time, their number is gradually reduced to zero.
• Pathology. Blood clots, pus, foul odor and profuse bleeding- this is the first signal that complications have arisen. There may be an infection, which may also cause irritation or itching. It should be noted that thrush often occurs in the postoperative period.

How to speed up the rehabilitation process

A woman must lead correct image life after hysterectomy. The consequences for the body can be the most unpredictable if the patient does not comply with all established rules:

Psychological trauma

At this point we will talk about the last tip above. Indeed, life continues after removal of the uterus, so a woman who agrees to amputation must understand that in the future she will need to fight a certain psychological barrier. Let's look at them all:

The laparoscopic method gives women new life. This procedure does not cause adhesions like e.g. abdominal surgery by amputation, which involves opening the abdominal cavity and removing the intestines. After this procedure, women rarely experience psychological difficulties. After all, according to appearance you can’t say at all that any large surgical interventions. This step in medicine prevents the development of cancer and allows women to live a full life. The main thing is not to ignore alarming symptoms, which can sometimes save the lives of us and our loved ones!