Laparoscopic conservative myomectomy. Laparoscopic method for removing uterine fibroids. Indications for myomectomy in the absence of pregnancy

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Uterine fibroids are a benign neoplasm that arises from the muscular layer of the uterus. Can provoke the appearance of fibroids various reasons. This and hereditary predisposition, and numerous abortions, and problems with the menstrual cycle. However main reason are hormonal disorders in a woman’s body.

Is surgery always necessary?

If the tumor has no big sizes, there has been no tendency for its increase for several years, and the woman is not planning a pregnancy, you can resort to drug treatment. In many cases, hormonal medications can slow down and sometimes completely stop the growth of fibroids.

Usually several courses of hormonal treatment are prescribed.

Surgical treatment of fibroids is carried out if the tumor has reached a sufficiently large size and complicates the patient’s life. Of course, in almost all cases they try to perform a conservative myomectomy, that is, removal of myomatous nodes while preserving the uterus, especially in young women planning to have children in the future. However, it should be borne in mind that such a myomectomy does not exclude re-formation of the tumor, which will require a second operation.

Indications for surgery

Rapid growth of the tumor (in a year by an amount that matches the size of the uterus during pregnancy at 4-5 weeks).
The size of the fibroid for surgery must correspond to the size of the uterus during pregnancy at 12 weeks.
Uterine bleeding and decreased hemoglobin levels due to volumetric blood loss.
Expressed pain syndrome.
Concomitant gynecological diseases (endometriosis).
Suspicion of malignancy (cell atypia in histological examination).
Secondary changes in the tumor (infection, necrosis).
Myomas of any size, having long legs and prone to twisting.
A node that appears in the cervix or between the broad ligament.
Habitual miscarriages, infertility.
Significant dysfunction of nearby organs ( frequent urination, constipation).

Preparation before surgery

Before the operation, all standard studies are carried out: general tests blood and urine, biochemical parameters, coagulation testing, blood group determination, radiography chest, ECG. In addition, there is ultrasound scanning pelvic organs with precise determination of the location of tumors and their size, examination of the rectum, a smear on the flora from the vagina. Since hormonal disorders are the main cause of fibroids, a woman must also undergo a blood test for hormones.

After a thorough examination, conclusions can be drawn about the need for surgery. Surgical interventions with removal of the uterus are more acceptable for women in menopause, while operations with preservation of the organ are tried to be used in women under 40 years of age.

Types of surgery

The choice of type of operation will depend on the size of the tumor and whether it can be removed using one method or another. Main types surgical intervention are:

Myomectomy.
Embolization.
Radical hysterectomy.

Myomectomy

This is an operation to resect the tumor itself while preserving the body of the uterus. This can be done in several ways:

Laparotomy myomectomy is an abdominal operation in which access to the uterus is provided through an incision in the abdominal wall.

Now, in this century modern technologies, this type of surgical approach is used infrequently. As a rule, this is justified in cases where the uterus is severely deformed due to large quantity myomatous nodes or their large size.

After laparotomy, it is necessary long time avoid physical activity and carefully monitor the cleanliness of the seam. In addition, after this operation a scar remains on the abdomen. The positive aspect of laparotomy is the ability to control the progress of the operation by a doctor.

Laparoscopic myomectomy - a type of surgical intervention that allows the necessary manipulations to be carried out through small holes in the abdominal wall, resulting in no scars left on the body.

The advantages of such a myomectomy are that the recovery period after it is much faster.

However, this operation has limitations: the size of the fibroids should not exceed the size of the pregnant uterus at 9 weeks. In addition, if the node is located in a hard-to-reach place, laparoscopic surgery is not performed, since there is always a risk of bleeding, which in such conditions will be difficult to stop.

Hysteroscopic myomectomy

Hysteroscopic myomectomy – a method of removing myomatous nodes from the uterine cavity through the vagina. It is natural that this type intervention is used for small size myomatous nodes growing into the uterine cavity (submucosal location).

Hysteroscopic myomectomy can be performed in outpatient setting.

Contraindications to conservative myomectomy

Removing only the tumor without removing the uterus itself cannot be performed in the following cases:

The patient's condition was serious due to large blood loss and severe anemia. Leaving the uterus can cause life-threatening bleeding.
Tumor recurrence after previous organ-conserving surgery.
Chronic inflammatory process in the pelvic organs.

Hysterectomy

Complete removal of the uterus is considered extreme surgical methods treatment. This operation is prescribed for large, multiple fibroids that occur with severe complications.

Removal of the organ can be done either by laparotomy, laparoscopy or hysteroscopy.

There is complete extirpation of the uterus - that is, removal of it along with the cervix and supravaginal amputation (the cervix is preserved).

It must be said that hysterectomy is often carried out unreasonably; according to some authors, in 8 out of 10 cases it could have been avoided by prescribing the woman adequate hormonal therapy in preparation for surgery and then performing a conservative myomectomy.

Therefore, if the doctor insists on complete removal uterus, and the woman does not agree, it is advisable to consult another doctor.

However, some women who do not plan to have any more children agree to have the uterus removed, since it cannot be said that this operation does not have its advantages:

A woman gets rid of pain and bleeding, including menopause.
There is no risk of tumor recurrence.
There is no risk of developing endometrial cancer.
There is no need for contraception.

Uterine artery embolization (UAE)

is a minimally invasive surgical intervention, the essence of which is to stop the blood supply to the fibroids. During the procedure, a thin tube (catheter) is passed through a puncture in the artery in the thigh to the vessels that supply blood to the tumor. Through this tube, special substances are injected that clog the arteries and stop blood flow in them. As a result of disruption of the blood supply to myomatous nodes, the cells that make them up gradually die. After a few weeks these cells are replaced connective tissue. This tissue is resorbed, and the tumors either significantly decrease in size or disappear completely.

Recovery after surgery

The postoperative period lasts several weeks. When performing the operation using the laparoscopic method, the woman can get out of bed and walk already on the second day. With laparotomy operations, recovery takes longer. For three months after surgery, you should avoid heavy physical activity and wear postoperative bandage and try to avoid constipation, which can cause the seams to separate. In addition, disturbances in bowel function can lead to inflammatory diseases in the uterus and its appendages. Therefore, the foods a woman eats should help cleanse the intestines.

If the uterus was preserved during the operation, then after restoration of its inner layer in six months to a year the woman will be able to plan a pregnancy. As a rule, it is not complicated by anything.

Consequences of myomectomy surgery

The main problem with conservative myomectomy is the high risk that the tumor may form again, even if the surgeon is confident that the node has been completely removed. The following complications are also possible:

Development of the process of inflammation in the pelvic organs.
Development adhesive disease due to the appearance of adhesions between the uterus and fallopian tubes, ovaries, the end result of which can be infertility.
Further pregnancy and childbirth may be complicated due to postoperative scar on the uterus.
Recurrence of fibroids elsewhere in the uterine wall.

Complications of hysterectomy

There are many “horror stories” about the consequences of hysterectomy, which do not always correspond to reality. These include an allegedly increased risk of developing breast cancer and other organs, the inability to enjoy sex life, the onset of early menopause, and others.

All this very frightens women, especially impressionable ones, they refuse surgery, even if they need it for health reasons.

In fact, mastopathy, breast tumors and uterine fibroids are parts of the same pathogenesis, hormonal disorders in organism. Therefore, in patients with fibroids, breast diseases actually occur more often, and removal of the uterus does not affect them in any way.

According to reviews of patients who have undergone uterine amputation, sexual sensations do not weaken after this operation; all the nerve endings for obtaining sexual satisfaction are located in the vagina and cervix, which are preserved. Moreover, a woman stops experiencing pain during sexual intercourse, and also becomes more relaxed, since she does not need to think about contraception.

As for the onset of early menopause, a slight decrease in the synthesis of sex hormones is indeed possible, even if the appendages are preserved. The fact is that during the operation the ligament connecting the ovaries to the uterus is crossed. As a result, the blood supply to the ovaries somewhat deteriorates. Therefore, not all women, but it is possible:

Increased risk of occurrence and further development diseases of the heart and blood vessels in women under 50 years of age;
Increased irritability, insomnia, increased fatigue, depression, hot flashes;
Urinary problems may occur ( frequent urge to urination, urinary incontinence);
The appearance of pain in the joints;
Development of osteoporosis, and, as a consequence, increased risk of spontaneous fractures;
High probability of prolapse of the vaginal walls;
Possible weight gain as a result of development endocrine diseases, metabolic syndrome.

In addition to all this, emotional women may develop depression and begin to consider themselves inferior. Sometimes in these cases the help of a psychotherapist is required.

Cost of the operation

If indicated, it is possible to carry out free operation By compulsory medical insurance policy in public clinics.

In private clinics, the cost of operations varies greatly depending on the volume of surgery, the qualifications of the doctor and other factors. The approximate price range is shown in the table below.

Myoma is one of the most common diseases reproductive system in women aged 35-50 years. This is a benign tumor formed from the muscle tissue of the uterus. It can only be determined by examination or ultrasound. The disease is often asymptomatic, but there are a number of signs (irregular menstrual cycle, pain, bleeding, unsuccessful attempts to get pregnant) that should force a woman to see a doctor.

In gynecology, hormonal therapy, conservative myomectomy and radical hysterectomy are used today for fibroids.

Each case is individual. Once the patient has been diagnosed, specialists must determine the most effective treatment method. If nodes were found on early stage, they are small in size, and doctors do not see a growth trend; therapy with hormonal drugs is used - Duphaston, Norkolut, Decapetil, etc.

They help stop the progression of the disease and even stimulate tumor regression. When uterine fibroids deprive normal life Women cannot do without surgical intervention.

Not every woman when experiencing gynecological problems knows how best to act, what treatment methods are more effective to use in her situation. The doctor’s task is to explain to the patient what myomectomy is, what advantages it has, and what side effects may be observed after surgery.

In medicine, when surgery to remove fibroids cannot be avoided, two options are used: hysterectomy and myomectomy.

The first method is removal of the uterine body with or without appendages. Accordingly, after the operation the woman will not be able to have children. In addition, patients have a disorder of the nervous and autonomic system. A more loyal solution would be a myomectomy, during which all organs remain in place, reproductive function is preserved, and only the nodes are removed. But it is not always possible to use this option; indications for surgery are:

reproductive age;
the patient does not have children;
small tumor size;
structure of nodes (they are easier to remove if they have a base).

Conservative myomectomy has contraindications.

It cannot be carried out if the patient’s life and health are in danger. Serious condition women, large blood loss and falling hemoglobin are grounds for radical hysterectomy.

Also, removal of the uterus along with fibroids is indicated for inflammatory processes in the pelvis, recurrence of the tumor after myomectomy, impaired blood circulation of the tumor and tissue necrosis, and suspected cancer.

Doctors choose independently best option, based on the clinical picture of the disease, the individual circumstances of the case, the presence of indications and contraindications for the patient.

Features of myomectomy

The operation to remove nodes is carried out using high-quality modern equipment. The surgeon must have sufficient knowledge and experience so that complications do not arise after the operation. At correct technique removal, a high-quality scar will be formed, and the possibility of developing adhesions will be reduced to zero.

Before performing surgery, it is important to prepare the patient according to all the rules.

It is necessary to undergo all standard types of examination:

take a blood and urine test;
check biochemical parameters and coagulability;
determine blood type;
undergo an ECG, pelvic ultrasound and radiography;
examine hormone levels.

If during the operation the doctor opened the uterine cavity, three rows of sutures with vicryl threads will be required. This material is easily absorbed and does not cause a tissue reaction. The incision of the fibroid capsule is made in the upper pole of the node. This will avoid massive bleeding, damage to the walls of blood vessels and makes it possible to remove other nodes if there are several tumors.

At the final stage of the operation, the pelvic cavity is subject to drainage, after which special solutions are injected into it to prevent the development of adhesions.

During the first two weeks after surgery, a woman may experience bloody issues. Sometimes they last for the first month with maximum abundance in the first day.

Menstruation after myomectomy is restored as before. The first day after menstruation will be considered the date of the operation.

Methods of conservative myomectomy

Modern technologies are actively used in medicine, which makes surgery safer, and the body’s recovery is faster and easier. Thanks to innovation, node removal can be done different ways. The most popular and effective options are:

Laparotomy myomectomy. This is an abdominal operation in which the uterus is accessed through an incision in the abdominal wall. Laparotomy is used infrequently, mainly in cases of severe deformation of the uterus due to a large number of nodes. After the operation, the patient must carefully monitor the cleanliness of the suture. Physical activity over a long period is contraindicated for her. A noticeable scar remains on the abdomen.
Laparoscopic method . It can be called as painless and bloodless as possible. Access to the affected organ is through small holes in the abdominal wall. The postoperative period during laparoscopy is easy and without complications. However, this method can only be used if the size of the uterus with fibroids does not exceed 9 weeks. Also, laparoscopy is contraindicated if the tumors are located in a hard-to-reach place.
Hysteroscopic myomectomy. The presented method can be used on an outpatient basis. Removal of nodes by hysteroscopy occurs through the vagina. An important condition in this case, the size of the tumors will become small.

Each method has its own advantages and disadvantages. Your doctor should determine which option is best in your particular case. One more method can be added to the presented methods – embolization of the uterine arteries.

EMA– a minimally invasive intervention with which you can stop blood circulation in the fibroid. The tumor loses the ability to feed itself with blood, which is why its cells die within two weeks, the growth of the tumor stops, or the fibroid completely resolves. Embolization is carried out using a puncture femoral artery. From here, doctors with modern equipment will be able to clog the fibroid vessels.

Doctors' opinions on myomectomy

Gynecologists are the main experts in the methods and techniques of myomectomy. To understand more about the procedure, you need to study the reviews of specialists.

“Myomectomy is the most gentle way to remove tumors while preserving a woman’s reproductive function. Patients are reluctant to agree to abdominal surgery, but hysteroscopic myomectomy or removal of nodes using laparoscopy is gaining popularity every day. And this is not surprising, because the presented methods reduce the risks of bleeding and injury. internal organs“Rehabilitation after the procedure is quick and painless.”

“The main thing that doctors focus on when determining the method of removing fibroids is the effectiveness of the surgical intervention. It is important that women have no complications after surgery. Conservative methods of tumor removal allow patients to become pregnant and carry to term after recovery. healthy baby. Scars after the procedure are practically invisible, and hysteroscopic myomectomy leaves no scars or adhesions at all.”

Consequences of myomectomy and rehabilitation period

When a doctor prescribes a myomectomy, he must take into account all the details and features of the disease. Even if a specialist completely removes the nodes, this does not guarantee that the tumor will not return over time. In addition to fibroid recurrence, other complications occur:

inflammatory processes in the pelvis;
the occurrence of adhesions accompanied by pain;
infertility.

Such consequences can be prevented in the postoperative period if you follow the doctor’s instructions and organize correct mode. The minimally invasive intervention allows the patient to move on the second day after the procedure. Recovery may take 1-3 months.

For the first time after surgery, you should avoid physical activity and wear a bandage. It will be necessary to improve nutrition, because a woman should not be constipated.

They can cause seams to rip apart. Also disruptions gastrointestinal tract will be the reason inflammatory processes neighboring organs.

A woman's diet after a myomectomy should include foods that help cleanse the body of waste and toxins.

If the surgery went without complications, the chances of getting pregnant are 90%. Doctors recommend planning to conceive a baby six months after the procedure. It is during this period of time that the endometrium of the uterus will have time to recover, and the female body will have time to prepare for pregnancy and bearing a child. Learn more about myomectomy in the videos above.

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A conservative myomectomy is a surgical procedure that removes fibroids. At the same time, integrity is maintained reproductive organ, and, consequently, reproductive function women. Surgery can be performed hysteroscopically, laparoscopically or abdominally. In addition, today a minimally invasive method such as UAE is used to treat uterine fibroids. Due 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 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, respiratory dysfunction;
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 necessary when the size of the myomatous node exceeds 5 cm. With a myomatous node of subserous localization on a pedicle preoperative preparation are 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:

cardiovascular diseases, 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 follow bed rest, which is explained by 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 avoid taking baths and treat wounds with a 5% solution. 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 clear discharge, without bad smell and do not 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 to regularly visit a gynecologist and perform 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 postoperative period. 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. In case of removal of myomatous nodes from posterior arch vagina, for a period of about one to two months after the operation, the woman will have to give up sexual activity.

Pregnancy after conservative myomectomy

If there is a postoperative scar on the uterus, 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 are carried out: ultrasound examination (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 a high risk of uterine rupture 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 positive results surgical treatment of uterine fibroids 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 called surgery, the essence of which is the removal of the uterus from the body benign tumor(fibroids). Feature of this method of radical therapy for fibroids - preservation of women's menstrual and reproductive functions: only the tumor is removed, the uterus is minimally damaged. The degree of damage and the duration of the recovery period depend on the method of surgical intervention and the type of tumor.

Myomectomy is most effective when the tumor is located directly under the mucous membrane or under the serosa of the uterus. In this case, there is no significant defect in the muscularis propria. This type of surgery is also called conservative myomectomy. Conservative myomectomy is practically the only method for treating infertility caused by fibroids. In the recent past, myomectomy was used primarily in patients with reproductive period planning to have children in the future.

IN modern medicine Organ-saving surgery for uterine fibroids is a priority for radical therapy in women of any age.

Several varieties of the described operation are practiced. The choice of surgical procedure depends on clinical picture, the size of the tumor and its location in the uterus. Extensive abdominal operations to remove fibroids are used less and less nowadays: preference is given to endoscopic methods.

The types of myomectomy are as follows:

Laparoscopy;
Abdominal surgery.

Let's look at each method in more detail.

Hysteroscopic myomectomy

This operation is performed if the tumor is located directly under the mucous layer of the uterine wall and protrudes into the lumen of the organ (submucosal localization).
There is no external incision - the surgeon inserts an instrument (resectoscope) through the vagina into the uterine cavity and removes the node. The progress of the operation is monitored using a video camera equipped with a resectoscope or hysteroscope: the image is transmitted to the monitor screen.

This procedure is usually performed within 1 week. menstrual cycle. Local anesthesia or general intravenous anesthesia is used.

Advantages of this method:

No external cuts;
Reducing the risk of bleeding and infection;
Short recovery period;
Visual control of the procedure.

Prescribed in the presence of subserous (or intramural) tumor nodes. The instruments are inserted inside through small incisions (more precisely, small-diameter punctures) in the navel area. Along with surgical instruments, a mini-video camera is also inserted into the uterine cavity. Usually 2 (maximum 3) cuts per abdominal cavity.

Laparoscopy is a minimally invasive and minimally traumatic operation, which is preferred in many modern medical institutions. Most of the work is currently done using this method. gynecological procedures to eliminate pathologies in fallopian tubes, directly in the uterus and ovaries.

Abdominal myomectomy (laparotomy)

Elimination of fibroids using traditional abdominal surgery. During an operation performed under general anesthesia, 2 incisions are made - on the abdomen and on the body of the uterus. Visual control is direct: the surgeon monitors the progress of the procedure with his own eyes.

This operation takes longer because it involves suturing and requires a long postoperative period (about 6 months). A hospital stay is necessary for at least several days until doctors are sure there are no complications or infections. After the operation, a noticeable scar remains on the body.

Indications and contraindications

The main indications for myomectomy are: the size of the fibroid corresponding to 12-15 weeks of pregnancy and the tendency of the tumor to grow rapidly.

Other medical instructions for surgery:

Frequent vaginal bleeding(leading to anemia);
Dysfunction of nearby organs;
Submucosal type of tumor and other undesirable location options;
Necrosis of tumor tissue;
Infertility caused by the presence of a neoplasm (the tumor does not allow the fertilized egg to fully attach to the walls of the uterus).

The operation is not performed if patients have infectious lesions reproductive organs, There is chronic diseases liver, kidneys, heart, as well as blood pathologies associated with coagulation disorders. Myoma is not removed if there are multiple nodes (more than 4).

Postoperative period

After laparoscopy and hysteroscopy, the recovery period lasts only a few weeks. Wherein long stay in the ward is not necessary (maximum 3-4 days). For cupping pain symptoms(if any) analgesics are prescribed.

During the recovery period (1-1.5 months), patients should refrain from playing sports, lifting weights, visiting solariums and saunas, and having sex. In the next few (up to six) months, mandatory contraception should be used during sexual intercourse.

Approximate cost in Moscow

Myomectomy is performed in many specialized clinics in the capital. In particular, in:

"SM Clinic" on the street. Klara Zetkin, 33/28, tel. 777-48-49; Price - from 30,000 rubles;
at the "Best Clinic" on Spartakovsky lane, 2, building 11, tel. 241-8-912; The cost of the procedure is 38,000 rubles;
at the "Health Clinic" on Zeleny Prospekt, 17, building 1, tel. 672-87-87; Cost from 17,000 rubles.

The video shows a fragment of the program “Health with Elena Malysheva,” which shows bloodless laparoscopic myomectomy for giant uterine fibroids in a 25-year-old patient.

The only remedy for FIBROID and its prevention, recommended by Natalya Shukshina!

Myomectomy is a surgical technique for removing myomatous nodes, which occupies a significant place in modern gynecology. Today, laparoscopic myomectomy is considered the most common and effective. The main advantage of removing myomatous nodes using the laparoscopic method is that during the operation it is possible to remove tumors without damaging the uterus itself. Due to the fact that the most important reproductive organ retains its functionality, after laparoscopy a woman can become pregnant and carry a child.

What are uterine fibroids?

The main indication for laparoscopic myomectomy is uterine fibroids. This disease is considered one of the most common gynecological pathologies. According to statistics, uterine fibroids occur in approximately 50% of women reproductive age. Many representatives of the fair sex do not even suspect that they are developing this pathology, since fibroids most often do not have a bright severe symptoms and does not bring any concern to the woman. In most cases, the disease is detected accidentally during an ultrasound examination of the pelvic organs.

Fibroids, also called fibroids, are benign tumors that develop in muscle tissue uterus. The tumor is benign in nature and in rare cases can degenerate into malignant. Myoma can take the form of a single node, as well as multiple nodules covering the surface of the reproductive organ and deforming it. Myomatous node may have the most different sizes– from a few grams to a kilogram. Treatment gynecological disease- operational only.

Main advantages and technique of uterine myomectomy

One of the most important advantages of laparoscopic myomectomy is that during the process surgical treatment The tumor itself is removed directly, and the reproductive organ remains intact. It is the removal of the myomatous node by laparoscopic method that is the most preferable option for nulliparous girls. But, in turn, preserving the uterus also has an obvious disadvantage - in this case, the risk of developing a relapse of the disease cannot be excluded.

The following can be distinguished positive sides laparoscopic removal of myomatous nodes:

Minimum level of injury. Since surgical intervention during laparoscopy is carried out without direct penetration into the abdominal cavity, the risk of accidental damage to other internal organs is minimal.
With this surgical treatment, in most cases there is no bleeding.
There is no adhesive process after laparoscopic treatment.
This type of surgical treatment does not leave visible stitches or rough scars on the surface of the abdominal cavity.
In the process of removing a myomatous node, surgeons do not resort to amputation of the reproductive organ. Thanks to this, already some time after the operation, a woman can plan a pregnancy and give birth to a child on her own, without resorting to caesarean section. Myomectomy is characterized by the fact that a small scar remains on the surface of the uterus, which has absolutely no effect on the birth process.
One of the main advantages of laparoscopic myomectomy is the short recovery period. In frequent cases, already 4-5 days after the operation, the woman is discharged from the hospital, and sometimes even earlier.

Laparoscopic myomectomy is recommended only if the myomatous nodes are single or small in size. In the case of multiple or large tumors, laparoscopy is not performed due to the high complexity and possible development severe complications.

The technique of laparoscopy for uterine fibroids is no different from this procedure performed for other diseases.

Using a trocar, the anterior abdominal wall is pierced in several places - most often in 4. Surgery is performed using general anesthesia, so the woman does not feel any pain.
A mini-video camera is inserted into one of the holes, which shows the abdominal cavity from the inside on the screen of a special monitor, while the other holes are used for inserting surgical instruments.
Before proceeding with direct surgical procedures, carbon dioxide is supplied to one of the holes made in the anterior abdominal cavity. This is necessary in order to make the surgeon’s work as accurate and convenient as possible. Carbon dioxide provides better visualization of the surgical field and the fibroid node, as a result of which there is no risk of careless damage to internal organs with laparoscopic instruments.
Next, surgical instruments are used to dissect the uterine cavity and directly remove the myomatous node. If the tumors are small, they are removed through holes made in the wall of the abdominal cavity. If the myomatous node is large, an incision is made in the lower abdomen or in the vaginal area to remove it. The neoplasm is dissected into several small parts, which are removed one by one.
Laparoscopic myomectomy lasts from 1 to 3 hours, depending on the number of nodules and their size. After the fibroids are removed, sutures are placed on the holes.

Contraindications to myomectomy

Laparoscopy for uterine fibroids is usually well tolerated female body and does not cause serious complications. But, like any other surgical intervention, the procedure has several limitations. Myomectomy is not recommended in the following cases:

If there is a suspicion of malignancy in any of the internal organs, laparoscopic myomectomy is not performed.
Contraindication to surgical treatment Uterine fibroids are a severe form of kidney failure.
Laparoscopic removal of myomatous nodes is contraindicated if a woman has various diseases of cardio-vascular system or respiratory organs.
When diagnosing diabetes mellitus Laparoscopy of fibroids is not prescribed.
If the size of the node in the uterine tissue is more than 10 cm, laparoscopic myomectomy is performed only after a preliminary course of hormonal drugs.
Obesity is considered relative contraindication. This means that surgery and removal of the fibroid node is permitted only after the woman’s weight has returned to normal.

On the first day after surgical removal a woman may be prescribed narcotic analgesics. This is done in order to reduce pain, which can be quite severe. In some cases, in order to prevent the development of inflammatory or infectious complications, anti-inflammatory or antibacterial drugs may be prescribed medications. In most cases, within 4-6 days after laparoscopic myomectomy and removal of the node, the patient is discharged from the hospital.

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