Experience of application of different surgical accesses in case of combined uterine pathology

Е. G. Zaitseva; Зайцева Е. Г.; А. G. Marenin; Маренин А. Г.; I. Y Zverev; Зверев И. Ю.; V. Kh. Biteev; Битеев В. Х.

doi:10.17816/JOWD87260

Experience of application of different surgical accesses in case of combined uterine pathology

Authors: Zaitseva Е.G.¹, Marenin А.G.¹, Zverev I.Y¹, Biteev V.K.¹
Affiliations:
1. Kirov Regional Clinic
Issue: Vol 54, No 5S (2005)
Pages: 37-37
Section: Reviews
URL: https://journals.eco-vector.com/jowd/article/view/87260
DOI: https://doi.org/10.17816/JOWD87260
ID: 87260

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Abstract

Introductions. In the structure of gynecological diseases combined uterine pathology requiring operative treatment comprises up to 20-30%. The advent of minor-invasive technologies in operative gynecology nowadays makes it possible to maximally adapt the administered operative treatment for a patient, to shorten the time of being at in-patient clinic, to improve the course of post-operative period.

Keywords

the use of various surgical operations, pathology of the uterus, surgical treatment, minimally invasive technologies

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Material and methods. We have analyzed the results of treatment of 807 patients with combined uterine pathology for the period from January 2002 to May 2005. Operative treatment was carried out for the following reasons with the presence of uterine pathology: complicated uterine myoma, adenomyosis, recurrent menometrorrhagia. The operations were performed with the usage of different accesses. The average age of the patients was 52 ± 2,1 years, the average uterus size was 11 weeks (from 5 to 22 weeks).

Results. We have performed 86 (10,45%) laparoscopic-assisted hysterectomies, 9 (1,12%) laparoscopic hysterectomies, 45 (5,6%) vaginal hysterectomies, 165 (20,6%) subtotal laparoscopic hysterectomies, 220 (27,5%) laparotomic total histerectomy, 282 (35,2%) laparotomic subtotal histerectomy. The reasons for hysterectomy were cervical pathologies, adenomyosis, the age of a patient. The choice of access was limited by the size of the uterus. In case of enlargement of uterine size of more than 13-14 weeks, laparotomic access was chosen and the fact that a patient had previous operations did not influence the criteria of the choice of access in most cases. The average operation time after learning to handle endoscopic method was as follows: in case of laparoscopic method - 60 ± 21 mins, vaginal access - 70 ± 20 mins, laparotomic access - 60 ± 31 mins. Thus, time criterion nowadays is not the main factor in the choice of operative treatment access. The average loss of blood was 120 ± 25 ml (from 50 to 900 ml). The main factor in the choice of approach to operative treatment in our case was the obvious advantage of the course of post-operative period in patients who had laparoscopic and vaginal hysterectomies. The average time of being at hospital after endoscopic operations was 6 ± 2 days, after vaginal operation - 6 ± 0,5 days, after laparotomy - 11 ± 3 days. The structure of postoperative complications showed obvious advantage of endocopic operative methods. In case of laparoscopic access at the stage of learning there were 3 (1,15%) cases of ureter thermic lesion, with no other severe complications. In case of laparotomic operations there were 2 (0,4%) cases of ureter lesion, 12 (2,4%), complications of the wound (seroma, suppuration, stitches), post-operative ventral hernia - 2 cases (0,4%), pelvic hematoma - 15 cases (3%), uterine artery bleeding - 1 case (0,2%), thrombembolia of pulmonary artery - 1 case (0,2%).

Post-operative restoring treatment required more intensive therapy in case of laparotomy.

Conclusions. Thus, nowadays we tend to prefer endoscopic and vaginal methods in operative treatment of combined uterine pathology. The limiting factors are the size of the uterus, sometimes presence of accompanying pathology, previous multiple operations in the abdominal cavity, especially peritonitis, and the experience of the surgeon.