In which cases is a complete hysterectomy indicated?

This is an automatically translated article.

The article was professionally consulted with Specialist Doctor II Pham Thi Tuyet Mai - Obstetrician and Gynecologist - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital.
Laparoscopic complete hysterectomy is a surgical treatment with the aim of removing the uterus, in cases of uterine fibroids, early endometrial cancer, and endometrial hyperplasia. and menorrhagia, medical treatment is not effective.

1. Laparoscopic complete hysterectomy

Laparoscopic total hysterectomy is a surgical treatment that removes the uterus. After a complete hysterectomy, the patient is not able to get pregnant. Therefore, doctors often consider in each case, the medical condition to remove the uterus completely.
Laparoscopic complete hysterectomy is becoming more and more popular because it is less invasive. After surgery, the patient will have a smaller scar compared to an abdominal surgery, less pain after surgery, faster recovery and reduced hospital stay for the patient.
However, laparoscopic complete hysterectomy is a difficult technique, and therefore requires a physician with extensive experience and training in this technique. During complete hysterectomy, it is easy to cause complications on the ureter when the tumor is too large.
To perform a laparoscopic complete hysterectomy, the doctor inserts a small camera and surgical instruments inside through a small incision in the abdomen. The excised uterus is then placed in a bag and brought out through one of the incisions in the abdominal wall or through the vagina.

2. Indications and contraindications for laparoscopic complete hysterectomy

2.1 Indications for laparoscopic complete hysterectomy Laparoscopic complete hysterectomy is indicated in the following cases:
Endometrial hyperplasia with no results medically treated Menorrhagia and no results from medical treatment Effective cervical damage: CIS, CIN II, CIN III Uterine fibroids Early stage endometrial cancer After egg abortion with indication for hysterectomy 2.2 Contraindication to laparoscopic complete hysterectomy Contraindication Indications for laparoscopic complete hysterectomy in the following cases:
The patient has contraindication to laparoscopic surgery due to systemic disease Endometrial cancer, cervical cancer, ovarian cancer stage Too late Uterine is too big People have many old surgery scars from many surgeries.

3. Steps for laparoscopic complete hysterectomy

The people performing laparoscopic hysterectomy are specialized doctors with extensive experience in hysterectomy using laparoscopic methods. In addition, medical staff need to prepare a laparoscopic system dedicated to obstetrics and gynecology before performing a complete hysterectomy
Step 1: Preparation Before surgery, the patient will be examined by a doctor. assessors, physical examination, and specialists to evaluate comorbidities. Counsel the patient and family about the risks and possible complications during and after surgery. In particular, the patient needs to prepare psychologically after a complete hysterectomy, it is not possible to get pregnant. Patients will be enema, personal hygiene, abdomen and vagina, bath with antiseptic solution. In addition, patients need to fast and fast for at least 8 hours before surgery. Medical staff prepare medical records and surgical medical records as prescribed. Step 2: Carry out laparoscopic complete hysterectomy. The patient lies in the gynecological position, with the head low and under endotracheal anesthesia. Then carry out surgical steps:
Stage 1: Trocar puncture Stage 2: Exploration of the entire abdomen Stage 3: Burn and cut 2 round ligaments Stage 4: Cut 2 lumbar-ovarian ligaments or 2 ligaments uterus and ovaries, if ovaries are preserved, then 5: cut the uterine artery, then 6: remove the uterus from the vagina, then 7: re-stitch the vaginal apex: vaginally or laparoscopically, then 8: check and Hemostasis Stage 9: Withdrawal of trocars and suture of puncture holes After laparoscopic complete hysterectomy, the patient should be monitored for hemodynamic factors, abdominal monitoring, and vaginal bleeding.
In summary, laparoscopic complete hysterectomy is indicated in cases of uterine fibroids, early endometrial cancer, endometrial hyperplasia, and heavy menstrual bleeding. ineffective, cervical lesions: CIS, CIN II, CIN III, and after ectopic pregnancy, hysterectomy is indicated. After surgery, the patient needs to be monitored, when there are any abnormal signs, it is necessary to immediately notify the medical staff for timely intervention.
Vinmec International General Hospital currently provides a package of screening and early detection of gynecological cancer, helping to detect 4 diseases early: cervical cancer, breast cancer, uterine cancer and ovarian cancer even when the patient has no symptoms.

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