To the question about selection of rational surgical route at hysterectomy

Full Text

Introduction. Hysterectomy is the most often intervention in gynecology up to present day. Varity of clinical situation is demanded individual relation in every case. Selection of surgical route at hysterectomy depends on the criteria for intervention, uterine size, accompanying gynecology and somatic pathology, interventions on organs of abdominal cavity in anamnesis, inflammatory diseases of internal genitals and endometriosis.

Objective of research is substantiation of rationality of surgical route at hysterectomy using laparoscopy, laparotomy and mini-laparotomy with laparoscopic assistance.

Material and methods. During the period from January 2004 to May 2005 in department of surgical gynecology of the D.O.Ott Research Institution of Obstetrics and Gynecology RAMS 55 hysterectomies using laparoscopy (1 group) were performed. Comparing groups comprised 50 patients after laparotomic hysterectomy (2 group) and 50 patients after mini-laparotomy with laparoscopic assistance (3 group) that had been performed in 2003-2005.

Results. Mean age of patients 1, 2 and 3 groups is 48 ± 5,3; 45,6 ± 4,2; 43,6 ± 7,9 years old, respectively. Mean duration of operations is 137 ± 33; 91,3 ± 11,6; 114 ± 11,2 minutes. Mean size of removed uterine is 9,2 ± 2,9; 13,6 ± 4,1 weeks of gestation; 317 ± 12,1 gramm (mean mass). Mean estimated blood loss is 87,3 ± 84,3; 392 ± 57; 71,6 ± 8,1 milliliters. Mean postoperative inpatient stay is 7,8 ± 1,3; 9,2 ± 1,6; 6,1 ±0,1 days. In first group postoperative complications comprised 3 cases (5,5%): infiltrate in pelvis, hematoma around stump and cystic-vaginal fistula; 9,4% - in 2 group and 5,0% - in 3 group.

Conclusion. Total laparoscopic hysterectomy is performed if there are following criteria for hysterectomy: uterine endometriosis, relapsing endometrial hyperplasia in combination with fibroids or uterine endometriosis, typical localization of fibroids which size is not exceeding 15 weeks of gestation. Mini-laparotomy with laparoscopic assistance is performed if there are atypical fibroids (cervical, over cervical, intraligamental nodules), large fibroids of any localization, rough fibrotic parametrical changes or decrease of uterine ligament. Traditional laparotomy is necessary to use in cases when uterine size is more than 18-20 weeks of gestation, severe fibrotic processes in pelvis, addition of adjacent organs to pathological processes, malignant diseases of internal genitals, necessary to be seriously intervented, contraindications to laparoscopy in consequence of accompanying somatic diseases.

About the authors

V. F. Bezhenar

The D.O.Ott Research Institution of Obstetrics and Gynecology RAMS'; Academy Obstetrics and Gynecology Medical- Military Academy

Author for correspondence.
Email: info@eco-vector.com

Doctor of Medical Sciences, Professor, Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg; Saint Petersburg

G. A. Savitsky

The D.O.Ott Research Institution of Obstetrics and Gynecology RAMS'

Email: info@eco-vector.com
Russian Federation, Saint Petersburg

N. N. Volkov

The D.O.Ott Research Institution of Obstetrics and Gynecology RAMS'

Email: info@eco-vector.com
Russian Federation, Saint- Petersburg

Е. N. Popov

Saint Petersburg State University

Email: info@eco-vector.com

Department of Obstetrics and Gynecology, Faculty

Russian Federation, Saint- Petersburg

R. P. Volkanov

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: info@eco-vector.com

Department of Obstetrics and Gynecology

Russian Federation, Saint- Petersburg

References

Supplementary files