To the women who are recommended a surgery solution – abdominal, vaginal or laparoscopic – we offer the possibility of the operation by the physician of our clinic chosen by them. The operation then takes the place in the premises neighbouring to the Gynecological and Obstetrical Clinic NN Bulovka. The advantage is the previous meeting with your surgeon trusted by you. You will get acquainted not only with the surgeon but with the whole operation team. You will be explained in detail the whole course of the operation, we provide a smooth course of the admitting process and of the whole stay in the hospital. If desired we arrange for you a stay in the hospital in the above-standard single-bed rooms. The advantage of this choice is that you will not become an anonymous part of the patients´ group and you will get acquainted with your physicians. All our physicians have the most possible specialization in the field and have worked for tens of years in the mentioned clinic, it means, they are also very well familiar with the environment where you are going to be hospitalized.
The name laparoscopy can be translated as “a view into the abdominal cavity”.
It is a method of the minimum invasive surgery when the access to the abnominal cavity is provided by means of the introduced trocars (5-12 mm thick small “tubes”) in to which an optical system and operating instruments are put in). Number of trocars (number of punctures) is 1 – 4 according to the art of operation. The optical system with a camera displays the operation field on the monitor display. The laparoscopy is a modern method. The technology as well as operating procedures are permanently improved and still more diseases can be in gynecology treated by this method instead of the classical operating approach when the abdominal cavity gets open by incision.
Reasons (indications) for performing the laparoscopy:
A wide spectrum of pathological states in gynaecology
- distinguishing of the inflammation of the gynaecological organs or of another organ
- detecting the reason of stelirity
- suspicion of the extrauterine pregnancy
- examination of the pains in the pelvis of the unknown origin
- suspicion of tumor etc.
The surgery is performed under the general anaestesia. After the disinfection of the skin of the abdominal wall ca a 1.5 cm incision into the skin closely under the navel will be done. Through this access will be then, by a filling needle, gas (carbon dioxid) introduced into the abdominal cavity. Then through the same way a 10 mm trocar and a laparascop will be introduced by means of which the surgeon follows the operation field on the display. From one, two or free auxiliary ca 0.5 to 1 cm skin incisions in the both abdomens the surgical instruments will be put in. During the operation the constant gas pressure in the abdominal cavity will be hold by the automatic system in order to secure the proper view and space necessary for the operation performance. Laparoscopic instruments enable wide range of operations – shearing, cutting, stoppage of hemorrhaging, sewing, rinsing, suction, use of laser and other. After the the performance is finished the trocars will be taken out from the abdominal wall and the gas is deflated again. The incisions will be sewed by several stitches.
- Cosmetic effect
- Incisions are healed quickly and practically no scars are left
- Considerably less post-operation pain and discomfort
- Considerably reduced time of the hospitalization time and the following sick leave
- Not all the patients can be operated in this way and it is necessary to strictly consider the conditions and possible complications of this operation method
It is the performance of inspecting the abdominal cavity in the laparoscopic way. If some indications of a disease are found which can be removed by a surgical intervention (adhesions, cyst on ovary, blinded Fallopian tube …) in the most cases “the surgery performance in accordance with finding” will follow.
If the reason for the laparoscopy is sterility, the so- called chromopertubation is added to the performance which means the dye instilling of the uterine cavity and observation of its penetration through the Fallopian tubes all the way to the abdominal cavity.
- older than 35 years having three children
- younger than 35 years having four children born repeatedly through a Caesarean section, if it is the third in the raw
- if the pregnancy could jeopardize a voman´s life or could cause heavy health damages, when the woman suffers from illness which is constantly the reason for the abortion.
It is necessary to present a written application signed by you (written consent) and the approval of the administra committee. The female sterilization is based on "having one's tubes tied". Through this method the transport of the ovum from ovaries into the uterus and its fertilization will be prevented.At present thanks to the development of laparoscopic methods this intervention is performed practically in this way only. The Fallopian tube is then interrupted by the thermal energy and scissors. This procedure does not take longer than 10 – 15 minutes. It requires a stay in the hospital for 2 – 3 days. It is a very safe contraceptive method with the pregnancy risk (Pearl index) 0.015 – 0.04 (number of pregnancies per 100 women per year). The operation itself is relatively easy with minimal complications. The operation is in the most cases irreversible and the sterilization is for the whole rest of the life. Through this the group of women for which the sterilization is suitable is determined. Those are mainly the women with the terminated reproduction.
Laparoscopic removal of the ovary and/or of the Fallopian tube, removal of the ovarian part (cyst)
The most frequent reason for undertaking this surgery is the cystic formation on the ovary, extrauterine pregrancy, a blinded and widened Fallopian tube after the recent inflammation (sactosalpix), non-pathological tumor on the ovary (dermoid, endometriom, fibrom). Sometimes, e.g. at the certain type of the breast cancer, in accordance with an oncologist´s recommendation, the both-sided removal of ovaries (= chemical castration) is performed. This approach is much less burdening than the abdominal incision, it enables the quicker reconvalescation and the earlier discharge for the home care.
This type of surgery is performed from the abdominal approach under the general anaestesia. Frequenly the so-called Pfannenstiel incision is used, i.e. a 12 cm horizontal incision just above the pubic hair. If the intervention cannot be done from this incision, the other method is the middle laparotomy, i.e. a vertical incision from the navel towards the pubic hair. All the taken out material is sent for the histotogical examination. The hospitalization after these operations takes 6 – 10 days when the operation process as well as the postoperation period is optimal. After the release into the home care it is necessary to prevent a physical strain and getting cold. If some problems occur in this period, especially the stronger vaginal bleeding or fiebers, an immediate check-up by the attending gynecologist is absolutely necessary. The sick leave after this surgery takes 4 – 6 weeks in average.
Abdominal hysteroctomy (surgical uterus removal through abdomen)
After opening the abdominal cavity blood vessel supply is closed step by step and afterwards the uterus will be removed (the uterus body together with the cervix). The open vagina will be blinded at the upper end and it is hung up onto the supporting connective tissue apparatus which before held the uterus in the right position. According to the circumstances the uterus appendages (ovaries and Fallopian tubes) are either taken off or left in various combinations. The appendages removal is mostly recommended to the women above 45 years or there where some finding on the ovary (cyst) exists. After the uterus removal it is natural that you will neither menstruate nor you can get pregnant. If in younger women the ovaries are left neither menopausal (climacteric) difficulties will occur as the hormonal function of the ovaries have not been violated and they will, step by step, fade away as if the woman has not undergone the surgery. In contradiction, after the removal of functioning ovaries the menopausal like difficulties (hot flashes, night sweating, sleeplessness, mood change …) mostly occur. This situation should be consulted with your gynaecologist in order to employ the suitable therapy (most frequently hormonal substitutions, i.e. hormons produced till that time by the ovaries will be given to you in a form of medicaments with which the hormonal function of the ovaries will be substituted. The condition for this is the preceeding performance of mammography = X-ray breast examination.) The sexual life is not affected by this surgery.
Vaginal hysterectomy (surgical uterus removal through vagina) and vaginal plastic surgery
The abdominal cavity is to be opened from the vaginal entrance – cutting through the vaginal wall in the place of the vagina insertion onto the cervix. After that the vagina will be relased from the ligaments and after the strangulation of the blood vessels which have not been interrupted during the laparosckopical phase the uterus will be taken out through the vagina. Then the closure of the abdominal cavity and of the vagina will follow together with its hanging up onto the pelvis ligaments. Sometimes by the descent of uterus it is necessary to make an additional vaginal surgery because the descent of the uterus is often accompanied by a different grade of that of the vaginal walls, too. Such modification of the descent of the vaginal walls makes necessary also the strengthening of the pelvic floor together with the plastic modification of the vagina. The plastic surgery is divided into the front and back and can be performed separately or together at once. If only the vagina wall is descending separately the plastic surgery of the vagina can be performed completely individually without the uterus removal (this, however, will be more likely done in younger women).
Postoperation process and the follow-up care:
- Owing to the fact that the part of the surgery is performed through the vagina it is necessary that for the period of at least four weeks more intensive hygiene is kept, frequent showering, no bathing or swimming in the stagnant water (i.e. in the bath, in the swimming pool and the like), which is the inflammation prevention
- From the same reason it is necessary to avoid lifting of heavy loads for the period of about 2 – 3 months so that a firm scar can be formed and you will not be bothered by the descent of the vagina
- Intercourse can be restarted in about 4 – 6 weeks
- The sick leave will be terminated in ca 2 – 4 weeks
Laparoscopically assisted vaginal hysterectomy – LAVH
Reasons (indications) for the surgery:
In indications for LAVH the indications for the classic abdominal hysterectomy mingle with indications for the vaginal hysterectomy. A limit to a certain extent is the size of the uterus, enorm obesity not enabling laparoscopy and associated diseases which prevent the general anaestasia in the laparoscopy. Thus the classic abdominal hysterectomy is being slowly replaced by this surgery consisting of 3 phases – laparoscopic phase, vaginal phase and after it is over the state inside the abdominal cavity will be laparoscopically checked again mainly because of bleeding, then the laparoscopic instruments are pulled out and small skin incisions in the navel and the abdomens will be stitched together.
- Uterine myoms (i.e. knots from the uterine muscle which can cause strong irregular bleeding not reacting on the therapy)
- Disease of endometria (uterine mucous membrane) such as polyps, precancerosis (= pre-cancerous changes) and early stage of cancer
- Changes on the cervix (the so-called dysplasia) and early stage of the cervical cancer (precancerosis and CA carcinoma in situ)
- Bleeding from the uterus not reacting on the hormonal therapy
- Uterus lesion
- Descent, a partial or full prolapsed of the cervicx or of the uterus especially when the surgeon expects adhesion in the area of the pelvis minor or if the removal of uterine appandages should be performed as a part of the surgery (adnexectomy)
Advantages of LAVH in comparison with abdominal hysterectomy:
- Lesser postoperation pain (lesser consumption of analgetics)
- More frequent mobilization (getting up from the bed) and out of this arising lower risk of vein complications during the postoperation period
- Earlier regeneration of the function of intestins. i.e. possibility to consume normal food
- Considerably shortened time of the stay in hospital, earlier return home
- Shorter time of the sick leave (reduction by ca 50 per cent)
- Cosmetic effect (smaller scars – scars are only small, short-line like in the area of the navel and in the both abdomens), the main scar is hidden in the vagina
Postoperation process and the follow-up care: are identical with the vaginal hysterectomy.