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Procedure Description

This is a modern operating technique in gynaecology(combined laparoscopic and vaginal access). It is serving for removing a pathologically changed uterus, or uterus together with ovaries and tubes.

It is used for the treatment of the following states:
1. multiple uterine myomatosis (the uterus is permeated with benign myomas)
2. uterine bleeding of women in the post-reproduction period that cannot be solved in any other way
3. painful states related to women's reproductive organs, especially after repeated inflammation or operations in the minor pelvis
4. benign diseases of the ovaries, in most cases in combination with the above mentioned diseases

First phase (laparoscopic): endoscopic instruments are introduced in the abdomen through three incisions in the abdominal wall, each of them just few mm long on the lower edge of the umbilicus and both groins. For reasons of clear arrangement and the need for a manipulation with the organs, the abdomen is filled with carbon dioxide.

The laparoscopic procedures are micro-surgeries performed according to an image 40 times magnified on a video screen. The result is a precise operation with minimum bleeding and minimum damage to sound tissue. In this way, the uterus or the uterus together with the ovaries and salpinges is released from the attachment in the abdomen. In the course of this phase we examine the whole abdomen and are able to treat other pathological conditions at the same time - eliminate adhesions, remove the pathologically changed appendix etc.

The second phase (vaginal) enables to remove the released uterus through the vagina.

LAVH method advantage (we perform 95% of all hysterectomies by LAVH): minimal operational stress for the patient, minimisation of post-operation adhesions formation, minimisation of blood loss (10 times less than in the case of a classic abdominal operation), absence of a large abdominal scar.

Time Schedule, After Procedure Condition

5 days long residential treatment, quick post-operation convalescence
 

Procedure Description

It is advantageous to perform both of these procedures at the same session during just one general anesthesia. A combination of hysteroscopy and laparoscopy yields a very substantial amount of information about the state of uterus, ovaries, fallopian tubes and related organs and speeds up the detection of cause of infertility. Many pathological states can be resolved during the same session as well. We can perform, for example, a correction of a septate uterus, a resection of intrauterine polyps, adhesiolysis in the minor pelvis, electrocoagulation of ovaries and so on. Anesthesia: General

Patient Status: Inpatient 3 days
 

Laparoscopy Description

The philosophy of least-invasive surgery is driven by the positive outcomes of shortened hospital stay, less postoperative stay, diminished recovery times and by good performance in a competitive free-market environment. Laparoscopy can be used as an important tool providing high diagnostic accuracy in many clinical occasions. These include both acute and chronic situations (ectopic pregnancy, pelvic inflammatory disease, adnexal torsion, endometriosis etc.). It allows pathological process to be diagnosed in a timely manner. A significant reduction in complications owing to delay in diagnosis is an apparent benefit. In addition to its diagnostic potential laparoscopy may be used to safely perform many surgical procedures. Anesthesia: General

Patient Status: Inpatient 2 – 4 days

Procedures Description

a. Tubal sterilization is historically one of the first surgical procedures performed via laparoscopy. The principle of the operation is to reach tubal occlusion through bipolar coagulation of fallopian tubes. The intent is to permanently terminate fertility. The procedure can be performed safely under local anesthesia.

b. Laparoscopic lysis of adhesions. Pelvic adhesions can be associated with infertility and chronic pelvic pain. They can vary from thin and avascular ones to thick, multilayered and vascular. Adhesions can involve all pelvic organs: uterus, fallopian tubes, ovaries, bowels, urinary bladder. Good results of adhesiolysis depend on the use of microsurgical technique. This approach uses the philosophy of gentle technique with small instruments and delicate tissue handling. Despite lengthy laparoscopic procedures most patients are discharged the day after surgery, have minimal complications and return to full activity within about 1 week of surgery.

c. Resection and ablation of endometriosis. Endometriosis is a clinical condition characterized by the presence of tissue resembling functioning endometrial mucosa outside the uterine cavity. Painful menstrual bleeding, pain during the intercourse and infertility are among the most common signs of the disease. Smaller superficial implants of endometriosis can be electrosurgically coagulated. For deeper lesions, excision can be taken along with the coagulation.