Laparoscopic Hysterectomy


Uterine fibroids are benign tumors that occur as a result of abnormal growth of the uterine muscle cells. Their occurrence is fostered by hormonal imbalance as well as genetic dispositions. Uterine fibroids are distinguished into three types, depending on location: submucosal, intramural and subserous. Every fifth woman after the age of 35 and every second woman after 50 who has not yet entered the period of menopause has uterine fibroids. 
In the first phase of growth, uterine fibroids do not have to cause any ailments, therefore, without careful examination, they are often impossible to recognize. Symptoms depend on the size of myomas and their location. Depending on location, uterine fibroids can cause: painful and heavy menstrual bleeding, intermenstrual bleeding, and abdominal pain. They can cause infertility, miscarriages and premature delivery. Tumors can also constrict neighboring organs and contribute to problems with passing urine or constipation. It should be borne in mind that in about 1.5% of cases, myomas may develop into a malignant tumor, i.e., sarcoma. 
The basic and only effective treatment of myomas is their removal with histopathological examination. Sometimes this can be preceded by pharmacological treatment to reduce the volume of myomas and decrease their blood supply. Treatment of myomas can involve enucleation if the uterus is to be preserved or removal of uterine body, changed by myomas with preservation of a healthy cervix. Preservation of cervix causes that the procedure does not affect the patient's life comfort. Due to the fact that the cervical ligament system remains intact during the procedure, the procedure does not change the anatomical structure of the genital tract from the vaginal side, and therefore, has no effect on sexual life, does not cause symptoms of pelvic organ prolapse, or symptoms of urinary incontinence.

Laparoscopic surgery requires not only specialized equipment and a properly prepared operating room, but above all an experienced and trained operating team. It is a procedure that requires the operator to be extremely precise, and at the same time, it requires huge spatial imagination, as the course of surgery and manipulation with micro tools is observed on a monitor screen. The procedure is performed under general anesthesia on an operating table that resembles a gynecological chair. It is inclined in such a way that the patient remains in the so-called Trendelenburg position, i.e., with the head slightly lower than the legs. The procedure begins with carbon dioxide administered to the abdominal cavity with a special needle to create the pneumoperitoneum. The gas lifts the abdominal wall upwards and “stretches” the intestines allowing introduction of laparoscopic instruments. Then, a camera and a light source are introduced into the abdominal cavity via a small, approximately 10-millimeter, cosmetic incision in the navel. The monitor produces a color image at a significant magnification, with a very high resolution. Additional micro tools are inserted into the abdominal cavity via three 5-mm incisions over the pubic symphysis. The uterine body, destroyed by fibroids, is cut off from the ovaries with their preservation, and then cut off from the cervix, also with its preservation. Then, a special tool called a morcellator is introduced into the abdominal cavity by slightly enlarging one of the previously made incisions. Thanks to this, the uterus with fibroids is “reduced” and removed from the abdominal cavity. After completing the procedure, tools are removed from the abdomen and the previously introduced carbon dioxide is released. Cosmetic seams are applied to wounds made due to insertion of tools. The patient is mobilized about 6 hours after the procedure. A few hours after the procedure, the patient can drink fluids, and after the appearance of intestinal peristalsis, she can begin to consume easily digestible foods. The patient is discharged home the day after surgery. As pain after surgery is very small, only generally available home analgesics are recommended to use. Returning to daily activities after the procedure is possible after 3 days, and returning to full activity takes about 7-10 days.

1-2 hoursDuration of the treatment

2 daysStay in the clinic


4 weeksRecommended stay under the supervision of a doctor

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