Vaginal hysterectomy of different radicality in the treatment of uterine deseases

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Objective. The aim of this study was the optimization of vaginal hysterectomy (VH) using laparoscopic technology (LAVH) in order to improve the results in the treatment of benign and malignant deseases of uterine. To determine the necessarity of LAVH, to learn the possibility of adnexectomy, pelvic lymphodissection, the use of needle keeper of original construction, to investigate the relationship of postoperative period between abdominal, LAVH and vaginal hysterectomy. The next aim is to study the results of surgical treatment in patients owing abdominal, vaginal and LAVH.

Patients. 273 women undergoing abdominal hysterectomy, vaginal and LAVH (group 1-100 VH, main indication - prolaps of uterus), group 2-65 LAVH, main indication is the combination of prolaps and benign tumour, group 3-57 women with benign tumour (myoma - 68%, cystadenoma - 30%, hyperplasia of endometrium - 37%, chronic inflomation of adnexis 21%), group 4-51 women with cancer of cervix (2 in situ, 9-Tla, 8 - T1b, 1 - T2a) and corporis of uterine (2 - in situ , 19 - T1 a, 10 - T1 b). All the women of groups 2, 3 and 4 were undergone LAVH. Group 5 -30 women with the cancer of cervix or corporis TlabNoMo, all of them were undergone abdominal operation. Laparoscopic operations were performed by the equipment of NPF “Endomedium”. We used biinstrumental bipolar coagulation and original needle keeper (patent 2223053, 2003). We used different level of laparoscopic mobilization from the cutting of lig. teres and infundibulum pelvica (LAVH-1), plica vesicouterine and Duglas with lig.sacrouterine (LAVH-2), cardinal lig. with a.a.v.v. uterine (LAVH-3), pelvic lymphodissection (LAVH-4), Celio - Shauta (LAVH-5).

Results. Indications to the LAVH have no differences in compare with the abdominal operations and have many advantages in compare with VH. In past laparotomy was a contraindication to VH. LAVH in 2, 3 and 4 groups was performed at the patients who had laparotomy in past at 25,5% (44). In the 4 group 11 cases of LAVH-4 (21,5%), 6- LAVH -5 (7,8%). Duration of operation LAVH - 4, 5 - 111 and 254 minutes, blood loss 154 and 733 ml. During lymphodissection usually 17-19 nodes were eliminated. Algoritm of LAVH indication is designed.

About the authors

N. А. Gabitov

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Kazan

А. R. Gybaidullin

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

Z. V. Mavlutova

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

References

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