How is surgery to remove uterine fibroids

Many women's disease are treated with surgery. operation on removal of uterine fibroids do more than others. More than 40 percent of all surgical procedures, which take place in the Department of Gynecology, carried about of uterine fibroids.

Indications for surgery

Uterine fibroids is among the most common pathologies of the female reproductive system. The disease is diagnosed in one out of three women in the reproductive age. uterine fibroids has several names. In the medical literature, you can also find the terms "LM" or "fibroid" uterus.

Fibroids - benign growths in the uterus, which consist of myometrial smooth muscle fibers. Uterine fibroids are multiple and single, are usually round or oval, and sometimes grow in the form of education on the leg.

In the early stages of tumor most often does not manifest itself. After the onset of symptoms, when a woman goes to a doctor about her disturbing manifestations of the disease, to treat fibroids conservatively too late - needed surgery.

fibroid size may be different. In the earliest stages of its discovery - it nodes, no larger than 2-3 millimeters. During ultrasound or magnetic resonance imaging diagnostician can determine the exact size of tumors, and the place of its localization. At normal viewing gynecological fibroids size is usually determined according to the increase in size of the uterus. Taking as a basis the uterus increasing rate both during pregnancy in weeks.

Small education have a size up to 25 mm, the average tumor size of 50 mm, large and giant nodes represent 80 mm or more. The size of uterine fibroids is essential to choose the tactics of treatment. When the average size of the LM over 30 mm is often necessary to do the surgery.

Uterine fibroids large and small can have the following options for localization:

• submucous;
• subserous;
• retroperitoneal;
• intraligamentarnaya;
• intramural.

submucous nodes quickly reach a large size due to the rapid progression.

Tactics of treatment also depends not only on the size of fibroids, but also its ability to grow. The slowest growing tumors are simple, while proliferating education progress a bit faster. This is due to the histological structure of fibroids.

Easy and proliferating tumors are benign pathologies. When predsarkome detected giant cells with multiple cores. When growing fibroids often have to do the operation, as such tumors in a short period, we are able to achieve in the size of several tens of millimeters.

Typically, when symptoms of uterine myoma larger than 3 cm. If leiomyoma size greater than 80 mm, it is possible the appearance of compression of internal organs. While squeezing the bladder and intestines large tumors arise constant urge to urinate, and constipation. If you violate the functioning of internal organs need to do the operation.

surgical method It is the main method of treatment of fibroids. When the size of uterine myoma for the operation are important, but not paramount. Among the indications for surgery for fibroids are:

• the rapid growth of tumors to a large size, thereby squeezing the internal organs and impairs their functioning;
• bleeding due fibroids considerable dimensions;
• anemia, which is not possible to stop drug therapy;
• tumor size of more than 3 cm;
• torsion legs and necrosis of fibroids;
• severe pain;
• comorbidities ovarian or uterine body;
• reproductive disorders due leiomyoma;
• oncologic alertness.

Despite the large size units, to do the operation is not always possible. Doctors are the following contraindications to, to do the operation:

• inflammatory diseases in an acute form;
• Some cardiovascular disease and liver disease in sub-step and decompensation;
• unrealized reproductive function (radical techniques);
• intolerance to anesthesia.

When selecting varieties of surgery, the doctor must take into account:

• fibroid size;
• localization of education;
• age of the patient;
• type tumors;
• histology results and other tests;
• presence of concomitant diseases.

To make a choice of tactics affect fibroid size and its localization. operation normally do when fibroids 3 cm.

Several decades ago, pathology detection could mean not only the operation but also the removal of the uterus. In modern gynecology make sparing operation to effectively carry out the removal of fibroids while preserving the uterus.

types of operations

In the presence of uterine fibroids, doctors do the operations as of organ and radical nature. Interventions to remove uterine fibroids include:

• myomectomy;
• EMA or embolization of uterine arteries;
• FUS ablation;
• hysterectomy and extirpation.

myomectomy It means removing leiomyoma one of three methods.

1. Laparoscopy. This operation is performed using a laparoscope and puncturing a small value for the premises and equipment video camera into the abdominal cavity. The advantages of the method include the absence of pronounced adhesions. However stop the bleedingWhich may occur during laparoscopy, it is quite difficult. Laparoscopy often make when subserous leiomyomas average.
2. Laparotomy. Operation is performed through an incision in the lower abdomen. This is one of the most traumatic and outdated methods.
3. Hysteroscopy. Operation is a minimally invasive intervention in which the uterus through the vagina is introduced for manipulating the hysteroscope. The method is suitable for the removal of submucosal fibroids.

When producing an urgent unplanned removal of uterine fibroids for urgent reasons, always do a laparotomy, implying abdominal operation.

Uterine artery embolization can be done when submucous fibroids. During minimally invasive intervention the patient through the femoral artery administered substance violates power leiomyoma. As a result of circulatory disorders node eventually disappears or decreases its value.

FUS ablation It involves minimally invasive procedure, which is made by means of ultrasonic waves. Manipulation is performed under MRI control and shows the average size of the fibroids. Treatment has certain contraindications, such as signs of malignancy.

Hysterectomy and hysterectomy do with the concomitant risk of malignant disease or prolapse of the uterus. Gynecologists often recommend such surgery for women with large fibroids after menopause. The operation has a lot of remote complications, in connection with which it made only in exceptional cases.

Operation supplemented conservative therapy involving reception of hormonal preparations. An integrated approach to minimize the risk of recurrence.

Preparatory stage

Preparing to remove fibroids includes research that is a woman before the intervention:

• gynecologic examination (two-handed and by mirrors);
• medical history;
• vaginal swabs genital infections and flora;
• ultrasound examination of the uterus, cervix and ovaries;
• general and complete blood count;
• general urine analysis;
• an electrocardiogram;
• coagulation.

In addition, your doctor may prescribe to do hysteroscopy and MRIs of the pelvic organs. In some cases, consultation is required specialists, which extends the patient to obtain an opinion.

Features and duration

Volume manipulation during operations, a time period during which intervention lasts, the length of the recovery period depends on the specific type of surgical technique.

Laparoscopy

Laparoscopy - the most modern and gentle way to remove fibroids. Before the operation, carried out a standard preparation, which includes delivery of all necessary analyzes. The day before the operation is necessary to follow a diet and do not eat at least 12 hours before the operation.

Laparoscopy is carried out in a hospital under general or epidural anesthesia. General anesthesia - medication sleep. Epidural anesthesia provides only a loss of sensitivity in the lower body, so it has less contraindications and avoids the classic side effects after application.

Through a small incision in the navel gas is introduced to expand the abdominal cavity. During the operation, make several small incisions in the front wall of the abdomen to the equipment room. Through them, using a laparoscope passes deleting nodes.

The operation usually takes less than two hours. When the operation is carried out on the overlay procedure seams microcuts in the uterus and abdomen.

Laparoscopy in the hospital need to spend three to five days. After discharge, the woman is at home treatment for approximately ten days.

hysteroscopy

hysteroscopy - the most gentle way to remove fibroids. Minimally invasive hysteroscopic method can only remove fibroids no more than two centimeters in diameter. Preparing to remove is passing all tests for normal gynecological surgery.

A woman seated on an examination table, and treated the inside of the thighs, vagina and cervix special antiseptic. Then introduced into the vagina mirror operate anesthesia. After some time, the expansion is carried out of the cervical canal and administered hysteroscope into the uterus.

Hysteroscopy usually takes no more than one hour, together with the preparation and rarely accompanied by any complications. Hospitalization lasts from two to 24 hours. A few days later a woman can go to work.

laparotomy

Laparotomy often held under emergency circumstances and situations. The only way to remove the fibroids, germinating deep into muscle tissue and having a larger size (Over 20 weeks), the formation of multiple, fibroids with torsion legs cause bleeding and necrosis tissues.

abdominal operation made under general anesthesia (drug-induced sleep) as lasts at least 1.5 hour. During operation is carried cut in the abdominal wall and uterus. After removal of the fibroids, the doctor conducts visual inspection and sutured to the abdominal wall and uterus.

Despite the high risk and a fairly long period of rehabilitation, laparotomy passes often enough, since only this type of operation allows the surgeon full control over the process of removing the fibroids difficult to prevent possible bleeding and possible accurately stitches on uterus.

Hospitalization at laparotomy lasts 5-7 days, after which the woman can be in the hospital for another two weeks.

Hysterectomy

A hysterectomy involves removal of the uterus. This radical method, which provides life to get rid of fibroids recurrence. The risk of degeneration into malignancy in postmenopausal - indication for hysterectomy.

There are two types of hysterectomy:

• supravaginal (Subtotal) amputation;
• extirpation (Complete removal of the uterus and the cervix).

Regardless of the type of hysterectomy, surgery is performed under general anesthesia through abdominal incision. Hysterectomy takes 1.5-2 hours.

hospitalization takes the period of one week to ten days, and complete recovery period lasts an average of 1,5-2 months.

Surgery for fibroids administered approximately thirty percent of the cases. The choice of method of its implementation depends on many factors, including the localization of lesions, their number, the patient's age, the need to preserve the reproductive function.

If a woman scheduled for surgery, you should not postpone it. Fibroids - is education, which tends to increase. The earlier removal of passes, the less traumatic and more gentle it is.