Ovarian cysts and ovarian tumors
OPERATIONSModern minimally invasive treatment of prolapse – lateral hysteropexy using the Dubuisson’s method. Stress urinary incontinence Tubal dropsy Vaginal surgery (vaginoplasty) Lowering of the reproductive system Infertility Uterine myoma Labia hypertrophy Ovarian cysts and ovarian tumors Endometriosis
An ovarian tumor is a broad term for all pathological changes in the ovaries, both those that are functional, that is disappear away on their own, as well as progressively growing changes and continuous changes that often endanger the health and life of the patient. Tumors are divided into so-called solid tumors and cystic tumors (cysts) containing mostly liquid. There may also be tumors with a mixed structure called solid-cystic tumor. Tumors can occur individually or in a bigger number. Tumor sizes are also different – they may be the size of a nut, but there are tumors the size of a watermelon. However, the most important thing for a patient is whether the tumor is benign or malignant.
Small tumors rarely produce clear symptoms. Often, their detection is a pure accident, e.g., as a result of a follow-up ultrasound. The larger ones usually already give clear symptoms, which include lower abdominal pain, bloating, constipation, pollakiuria. One of the disturbing signals that may indicate ovarian tumors are menstrual irregularities, spotting and breakthrough-bleeding, headaches, nausea or vomiting. Approximately 5-6% of ovarian tumors has hormonal activity. So far, no clear reasons for the formation of ovarian tumors have been established.
The diagnosis of ovarian tumors consists of performing a transvaginal ultrasound, sometimes performing computed tomography or lesser pelvis magnetic resonance imaging. Blood tests in the direction of the so-called cancer markers Ca-125, He-4, Ca 19.9 are helpful to make a diagnosis. However, sometimes even these tests are not enough to make the final diagnosis. Laparoscopy may be of help, which may have both a diagnostic nature (sampling for histopathological examination) and be a medical procedure (laparoscopic removal of the uterus with appendages and lymph nodes). Increasingly all over the world, laparoscopy is applied in the early diagnosis and treatment of malignant ovarian tumors.
Treatment of ovarian tumor depends on the severity of the disease and the nature of the tumor. Mild tumors can be excised from the ovary, borderline tumors are most often removed with the entire ovary and fallopian tube, performing the so-called removal of appendages. In cases of malignant tumors, it is often necessary to remove the entire genital area, the lymph nodes, the appendix and the retia. Next, most often chemotherapy is recommended. In younger women, the removal of ovaries means an accelerated menopause. Sometimes, her symptoms are more severe than in the case of natural ovarian function expiration. Then in some cases, the doctors decide to give the patient hormones, which soothe ailments.
Laparoscopic ovary tumor removal requires specialist laparoscopic equipment and a well-prepared operating theater, as well as a highly experienced and trained surgical team. It is a procedure that requires the operator to know the techniques of appendage preparation and removal of the reproductive organ and lymph nodes in case of such a necessity. The treatment is performed under general anesthesia on an operating table resembling a gynecological chair. It is bent so that the patient is in the so-called Trendelenburg’s position, i.e. with the head slightly lower than the legs.
At the beginning of the procedure, carbon dioxide is administered to the abdominal cavity through a special needle in order to produce pneumoperitoneum. The gas lifts the abdominal wall upwards and “pushes” the bowel allowing the insertion of laparoscopic instruments. Next, through a small, approximately 10-millimeter cosmetic incision in the navel, a camera and a source of light are inserted into the abdomen. The monitor allows to obtain a high-resolution color image. With three 5-millimeter incisions above the pubic symphysis, additional micro tools are inserted into the abdominal cavity. With their help, the ovarian tumor is fully excised or opened and emptied. The removed lesions are placed in a bag placed in the abdominal cavity (the so-called endobag) and removed from the abdominal cavity by one of the previously made incisions. At the end of the procedure, the tools are removed from the abdominal, and the previously inserted carbon dioxide is released.
Cosmetic seams are placed on wounds being a result of the inserted tools. The patient is mobile about 6 hours after surgery. A few hours after the procedure, the patient may drink fluids, and after the occurrence of peristalsis, he may begin to eat easily digestible foods. The patient is sent home the next day after surgery. Because pain after the surgery is very small, the only home remedies which are used are common analgesics. After surgery, it is possible to return to daily activities after 3 days and to full activity after about 7-10 days.