Optimization of laparoscopic hysterectomy method in fibroids surgery

Vitaly F. Bezhenar; Беженарь Виталий Фёдорович; N. N. Volkov; Волков Николай Николаевич; Е. N. Popov; Попов Э. Н.; R. P. Volkanov; Волканов Р. П.

doi:10.17816/JOWD87238

Optimization of laparoscopic hysterectomy method in fibroids surgery

Authors: Bezhenar V.F.¹^,2, Volkov N.N.², Popov Е.N.³, Volkanov R.P.⁴
Affiliations:
1. Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott
2. Medical-Military Academy
3. Saint Petersburg State Pediatric Medical University
4. State Medical University named after academician I.P. Pavlova
Issue: Vol 54, No 5S (2005)
Pages: 35-36
Section: Reviews
URL: https://journals.eco-vector.com/jowd/article/view/87238
DOI: https://doi.org/10.17816/JOWD87238
ID: 87238

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optimization of the technique of laparoscopic hysterectomy, surgery of uterine fibroids, uterine fibroids, laparoscopic hysterectomy

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Introduction. Hysterectomy is still the most often intervention in gynecology up to present day (Adamyan L.V. et al., 2000). The most often intervention all over the world after appendectomy is hysterectomy (Wattiez A., et al. 2003). Moreover hysterectomy is the most often performed gynecology intervention. In our days the majority of hysterectomies demanding laparotomy can be partly or fully performed by laparoscopic way (Kulakov V.I. et al., 2000).

Objective of present research is optimization of laparoscopic hysterectomy method in surgical treatment of patients with fibroids.

Material and methods. During the period from November 2004 to May 2005, 55 hysterectomies using laparoscopy were performed in department of surgical gynecology of the D.O.Ott Research Institution of Obstetrics and Gynecology RAMS.

Results. There were performed: 34 operations (61,8%) - total laparoscopic hysterectomy (TLH), 4 operations (7,3%) - laparoscopic subtotal hysterectomy (LSH), 4 operations (7,3%) - vaginal hysterectomy with laparoscopic assistance, one of which was operations with sling IVS (LAVH and LAVH+IVS), 4 operations (7,3%) - total laparoscopic hysterectomy with colpoperineolevatoroplastics (TLH+KPLP), 9 operations (16,4%) - total laparoscopic hysterectomy (TLH) with second vaginal stage - correction of the urine incontinence by sling IVS or TVT-0 and colpoperineolevatoroplastics (IVS/TVT-O+KLP).

The main indications for hysterectomy were the following: fibroids accompanied by uterine blleeding and anemia of patients - 44 (80%), in 26 cases of them fibroids combined with adenomyosis (47,3%) and in 8 cases pain syndrome took place - (14,5%). Plural fibroids were found in 24 patients (43,6%), quick growth and large sizes of fibroid - in 10 (18,2%). Adenomyosis manifested by meno- metrorrhagia and/or pain syndrome was the indication for surgical treatment in 9 patients (16,4%). In 3 patients (5,5%) the indication for hysterectomy was benign ovarian tumor. In one of these three cases it was in combination with fibroid and in another one - with adenomyosis. One patient had reccurent endometrial polyps (1,8%).

Conclusion. Total laparoscopic hysterectomy is the most often intervention in modem fibroids surgery. At the same time Harry Reich (1997) wrote “Laparoscopic hysterectomy is not used in those cases when there is a possibility of vaginal hysterectomy”. Vaginal hysterectomy is still the perspective method of operative treatment of benign uterine tumors. It can become a good alternative for laparoscopy methods.