Removal of the uterus in endometrial cancer
Endometrial cancer requires removal of not only the uterus with its cervix and appendages, but also the lymph nodes. EMC specialists perform this procedure using a careful and selective method, identifying sentinel lymph nodes. This technology allows you to remove one lymph node, which was the first to receive lymph: during the operation, it is determined in various ways, and then its urgent histological examination is performed. If no cancer cells are found in it, then with a probability close to 100%, they are not in other lymph nodes. This method avoids unnecessary complications after removal of all regional lymph nodes. Thanks to this approach, the recovery time after surgical treatment of endometrial cancer is significantly reduced.
Among benign diseases, multiple and large fibroids in a woman who does not plan to give birth anymore may be the reason for removal of the uterus. Hysterectomy is also performed for severe cervical dysplasia. In cases where conization has already been performed, the likelihood of recurrence is extremely high and the woman is not interested in constant monitoring of the cervix. It can also be adenomyosis, a benign pathology of the uterus that often leads to heavy and irregular periods, with severe pain, which severely affects a woman's quality of life. Adenomyosis is almost impossible to treat conservatively, so surgery is often required.
If we talk about malignant diseases, then hysterectomy is performed for endometrial cancer, cervical cancer (a special type of surgery is radical hysterectomy), and advanced ovarian cancer. During surgery, surgeons also remove regional lymph nodes to eliminate even the microscopic spread of cancer cells in them.
Hysterectomy is also required in some forms of genital prolapse (prolapse of the genitals), which is associated with overgrowth of the pelvic ligaments.
There are four methods of extirpation: through the vagina, through oral surgery, laparoscopic, and with the help of the da Vinci robot. Doctors choose the method depending on the disease, the features of the woman's anatomy and the diagnosis. To remove the uterus, abdominal surgery is very rarely used in EMC – only in 10%.
When the uterus is too large and the vagina is too narrow for vaginal surgery (this is most common in women who have not given birth), laparoscopy is performed using thin instruments.
If it is a benign disease, a hysterectomy is performed laparoscopically or with the help of a da Vinci robot. Then a morcellation is performed: the organ is carefully removed in a special bag through a laparoscopic port in a crushed state.
During laparoscopy, the patient loses almost no blood and quickly recovers after extirpation of the uterus.
If laparoscopic surgery is appropriate, then robotic surgery is also suitable. Operations with the help of the da Vinci robot are even more delicate and less traumatic than laparoscopic ones, which ensures less blood loss during surgical treatment and rapid postoperative recovery. For patients with high weight, it is especially preferable to use a robotic method of uterine removal.
Removal of the uterus through the vagina is often performed in patients with genital prolapse. It can also be a laparoscopic hysterectomy with a vaginal extension. Simultaneously, the gynecologist performs the stages of vaginal plastic surgery or pelvic floor muscle reconstruction.
If a woman has too large a tumor, the uterus increases greatly in volume (it often rises to the navel). Even if surgeons can insert laparoscopic instruments, they will not have the space to get to the vascular bundles of the organ and remove them laparoscopically. That is why abdominal hysterectomy is sometimes performed. This type of surgery is also used for patients with cancer, when the uterus is large and cannot pass through the vagina: its fragmentation is not oncologically safe, and the cost of risks is too high. Then abdominal operations are performed to remove the uterus. It is important to remove the whole thing without disturbing the tumor inside.
Among the disadvantages of abdominal surgery, there is a slightly more pronounced pain syndrome and slower recovery after surgical treatment compared to other methods (women spend 1-2 days in the hospital, and 3-4).
In comparison with other types of minimally invasive gynecological operations, specific preparation for removal of the uterus is not required. During the day, the patient performs intestinal cleansing procedures at home. Uterine extirpation is performed on an empty stomach, so patients should not eat or drink 8 hours before surgery. It is also important to remove all jewelry, avoid using makeup and nail polish, and take a shower.
2-3 hours before extirpation of the uterus, the patient comes to the hospital, the surgeon and the anesthesiologist talk to her again, after which the woman goes for surgery .
