Laparoscopic myomectomy to help the initiation of pregnancy
A myomectomy is performed on the body of the uterus to remove a benign tumour (myoma) from its muscle wall. The operation involves the removal of fibromatous nodes, while the body of the uterus is preserved, and the reproductive function is not disturbed. But not all myomas require removal, and some located in the uterine cavity are operated through the vagina using hysteroresectoscopy. Laparoscopy, as a method of removing fibroids, is suitable for young women who are planning a pregnancy and when the removal of the entire uterus due to multiple neoplasms is out of the question. Myomas are most often removed with the aim to become pregnant. After removing the myomatous node, a woman can plan a pregnancy in six months.
Removal of fallopian tubes as a method of precaution
In case of an emergency, the fallopian tube is removed during an ectopic pregnancy if it ruptures due to the growth of the ovum in it. But there are cases when operations on the fallopian tubes are carried out in a planned manner - for a possible improvement in the chances of pregnancy (adhesions in the tubes) or, conversely, as a radical method of preventing pregnancy. This method is fitting if the woman plans to never have children again.
Modern gynaecology no longer talks about “ligating” the tubes, but only about their complete removal. There is an assumption that the aggressive form of ovarian cancer originates in the fallopian tubes. Therefore, during a laparoscopic operation, the patient also receives protection from cancer risk at the same time.
The irreversibility of this contraceptive method is always discussed with the woman before the operation takes place. If in the future the patient still wants to become pregnant, this is possible only with the help of artificial insemination. The operation is performed at any age, from the age of 25 until the onset of natural menopause.
Often women are afraid of surgery due to various prejudices. While it is believed that after the removal of the fallopian tubes, menstruation will stop forever, it is a myth. After the operation, nothing changes in a woman's life, except for the impossibility of getting pregnant naturally. The absence of tubes does not affect hormonal levels: a woman may have the same painful or heavy menstruation, cysts and fibroids that occur without surgery. It is also false to claim that the surgery to remove the uterus kickstarts menopause. A woman with a removed uterus stops menstruating, but otherwise nothing else will change. The ovaries are responsible for hormonal activity, and they continue to function when the uterus or the fallopian tubes are removed.
Endometriosis: to operate or not to operate?
When and how to operate on endometriosis is a complex topic. But here, if surgical intervention is necessary, preference is also given to laparoscopy: it is easier to determine where the endometriotic foci are located, to which organs (intestines, bladder) they have spread. When choosing treatment tactics, an individual approach to the patient is very important, because this is a high-risk disease: if it is decided to operate on endometriosis, the doctor tries to remove all the lesions at once in one manipulation.
Laparoscopic metroplasty after Caesarean section
In women who have undergone a Caesarean section, a Caesarean scar defect may occur. Usually, with this problem, a woman complains of prolonged spotting after menstruation - this is due to a delay in menstrual blood in the scar niche. It is also necessary to treat this problem if a new pregnancy is planned - it may be associated with the threat of rupture of the uterus and abnormal attachment of the placenta in the area of the scar.
Performing laparoscopic reconstructive metroplasty for such defects after Caesarean section is now considered the main method for solving this problem. This allows a woman to plan a new pregnancy in 3-6 months, but it will only be possible to give birth to a child by Caesarean section.
The problem of cervical insufficiency is solved before pregnancy
Here we are talking about miscarriage due to insufficiency of the cervix - under the influence of intrauterine pressure due to an enlarging foetus, the cervix spontaneously opens ahead of schedule. Previously, the cervix was sutured through the vagina when the woman was already pregnant and if there was a threat of miscarriage.
Now, if this problem is known (for example, a woman has already had miscarriages), it is possible to perform an operation before pregnancy. The best result is achieved by using cervical cerclage - suturing of the cervix – this procedure is done laparoscopically. During the operation, the inner part of the cervix is compressed with a strong synthetic tape.
Cerclage does not prevent a woman from getting pregnant, and if this happens, it does not allow the cervix to open ahead of time. A big plus of the operation is that it can be done just before pregnancy and reduce the risks of foetal loss, for example, due to infection. In rare cases, cerclage is done during pregnancy, also without touching the foetus. After such an operation, birth can only be given by Caesarean section.
Correction of uterine prolapse
Laparoscopy is considered to be the gold standard in the treatment of pelvic prolapse. In the past, synthetic vaginal implants were used to return organs to their normal position. Now they are used less often. At the Lipex clinic we also treat this problem with the help of laparoscopy: a special mesh is installed that lifts and holds the vagina, bladder, intestines and uterus. This operation has shown very good results. The woman regains normal pelvic anatomy and all the functions - she can regain her sex life, play sports, be active and feel good.
All these and other minimally invasive gynaecological surgeries are performed in the LIPEX clinic. You can sign up for a consultation with a gynaecologist by phone (+371) 67333322
