Extirpation of the uterus with appendages

The uterus is one of the most important organs of the female reproductive system. In the presence of various serious gynecological diseases, doctors try to preserve the woman's reproductive function as much as possible, but this is not always possible. In such cases, extirpation of the uterus or hysterectomy is performed - an operation that involves the complete removal of the uterus. This surgical intervention is radical, therefore, it is carried out in case of emergency, when alternative methods of treatment have been ineffective or are inappropriate.

Types of hysterectomy

Depending on the volume of tissue removed, there are:

• Subtotal hysterectomy is an intervention that involves partial removal of the uterus while preserving the cervix. Its other name is supravaginal amputation of the uterus.
• Total hysterectomy - involves resection of the uterus together with the cervix;
• Radical surgery - in which the uterus is removed along with the appendages, the upper part of the vagina, the surrounding lymph nodes, and tissue.

The volume of surgical intervention is determined by the attending physician individually, taking into account the course of the underlying disease, the patient's age, examination results, and the presence of concomitant diseases.

Extirpation of the uterus: indications and contraindications

Removal of the uterus is indicated in the following cases:

• with oncological diseases (most often - endometrial or cervical cancer);
• benign neoplasms of large size or with severe clinical symptoms (fibroids);
• endometriosis of the body of the uterus, which does not respond to conservative treatment;
• the presence of combined pathology of the appendages and endometrium in patients in the perimenopausal and postmenopausal periods;
• abnormal uterine bleeding leading to chronic secondary iron deficiency anemia;
• severe pelvic organ prolapse.

Like any surgery, hysterectomy has its limitations. Among the contraindications are:

• acute infectious diseases;
• inflammatory diseases of the pelvic organs;
• severe somatic pathologies in the decompensated stage;
• violation of blood coagulation processes;
• oncological diseases of the 4th stage, with the presence of distant metastases and tumor invasion into neighboring organs.

Preparing for surgery to remove the uterus

A comprehensive preoperative examination begins with a consultation with an obstetrician-gynecologist, a thorough history taking, and referral to laboratory and instrumental studies. It will be necessary to pass a general blood test, urine test, biochemical blood test, coagulogram, determination of the group, and the Rh factor. Also, a smear is prescribed for cytology and microflora, ultrasound of the pelvic organs, CT or MRI. The specialist may prescribe additional examinations depending on the presence of concomitant diseases. It is worth warning the attending physician about all medications taken on an ongoing basis, as well as about the presence of allergic reactions to anything. Before the operation, it is necessary to consult with related specialists: anesthesiologist and therapist.

A few days before the operation to remove the uterus, it is recommended to switch to a light diet. For 8 hours immediately before the intervention, it is forbidden to eat and drink.

How is the operation going?

Hysterectomy can be performed through the abdominal approach, using progressive laparoscopic techniques and traditional laparotomy, or through the vaginal approach. The most actively used technique is the laparoscopic surgery to remove the uterus, as this intervention has several advantages:

• accuracy of surgical procedures due to constant video monitoring;
• minimal trauma (the entire operation is performed without incision of the anterior abdominal wall, only through punctures);
• good cosmetic effect;
• short rehabilitation period;
• reduced risk of intra- and postoperative complications.

The operation is performed under general anesthesia. To begin with, 3-4 punctures are made in the anterior wall of the peritoneum, through which special instruments are inserted, equipped with a video camera and illumination. To raise the abdominal wall and provide a good visualization of the operating field, carbon dioxide is injected inside. The correctness and sequence of surgical procedures are controlled using an optical device located in the abdominal cavity. During the operation, the uterus is cut off and removed through an incision, and the uterine arteries are ligated. At the end of the surgery, hemostasis is monitored and the trocar openings are sutured. The duration of the operation, as a rule, is from 1.5 to 2.5 hours (depending on the intraoperative situation, the size of the uterus, etc.).

Consequences of the operation

On the first day after laparoscopic surgery to remove the uterus, a woman is allowed to get up. Within a few days, pain in the area of the intervention is possible, for the relief of which the surgeon will prescribe pain medications. Possible consequences of hysterectomy include constipation, temporary difficulty urinating, and dirty vaginal discharge.

When the uterus is removed, but the ovaries are preserved, the hormonal background in a woman hardly changes, and, despite the absence of menstruation, her body continues to function under conditions of the normal content of female sex hormones. In the case of extirpation of the uterus with appendages, currently, safe and effective methods of correcting hormonal imbalance have been developed. This treatment is prescribed by a gynecologist-endocrinologist.

The cost of the operation of removing the uterus in Kyiv

Leading specialists of the Dobrobut network of medical clinics offer to carry out the operation of removing the uterus in Kyiv. Many years of experience of highly qualified surgeons of our clinic and modern first-class equipment contribute to the successful operation and the speedy return of the patient to the usual rhythm of life.

The cost of the operation to remove the uterus is determined individually and largely depends on the characteristics of the disease, the passage of additional examinations, the method of the operation, etc. However, the prices for our services are affordable in comparison with the prices in Ukraine. You can clarify the cost of procedures on our website.

How to sign up?

You can sign up for a consultation with a gynecologist, as well as clarify all your questions, by calling our call center or using the feedback service.

Bibliography

1. American College of Obstetricians and Gynecologists - Hysterectomy. Last updated: January 2021.
2. New York State Department of Health - Hysterectomy. Published online, April 2017.
3. Hysterectomy - Endometriosis | Fibroids | MedlinePlus. Last updated June 14, 2021.
4. Abdominal hysterectomy - Mayo Clinic, Published online, April 27, 2021.
5. Hysterectomy. Last updated, 01 February, 2019.