Gynecological-surgical procedures

Minimally invasive operations also play an increasingly important role in gynecology. These procedures are very gentle, as they are performed either through the body's natural openings (endoscopically) or through the smallest incisions (laparoscopically). Patients benefit from these modern micro-invasive techniques because the procedures result in fewer scars, less painkiller consumption and faster recovery and thus shorten hospital stays – if they cannot be performed on an outpatient basis anyway. Even in invasive procedures, the most modern techniques are used to keep convalescence as successful and short as possible.

Fibroids – Causes and Treatment

Fibroids are benign tumors in or on the uterus. Most are small, do not cause any noticeable symptoms, and are discovered rather by chance during routine examinations. However, if the growths are larger or located unfavorably, they can cause various, sometimes very unpleasant symptoms such as unusually long menstrual periods or intermenstrual bleeding. In addition to bleeding, fibroids can cause additional severe, cramp-like pain during menstruation – but not only then. Even outside the menstrual period, women with fibroids sometimes suffer from pain or a feeling of pressure in the lower abdomen or lower back. When larger fibroids press on adjacent organs such as the bladder or the intestine they can cause additional symptoms such as frequent urination or constipation führen.

The causes of fibroids are not exactly known, but since they grow under the influence of the sex hormones estrogen and progesterone, they primarily occur in women of childbearing age. Women after menopause usually no longer have symptoms, as the growths usually regress. Estrogen and progesterone grow, they primarily occur in women of childbearing age. Women after menopause usually no longer have complaints, as the growths usually regress.

Treatment of fibroids

In myomectomy, fibroids are surgically removed. Depending on the location and size, this is done through the vagina (hysteroscopic myomectomy), through a laparoscopy (laparoscopic myomectomy), or through an abdominal incision (myomectomy via laparotomy). The vaginal procedure is suitable when a fibroid protrudes into the uterine cavity, i.e., for fibroids located on the uterine wall or under the uterine lining. A procedure through the vagina is usually faster, and blood loss is less.

Laparoscopy and abdominal incisions allow the removal of fibroids that grow outwards into the abdominal cavity. Fibroids that lie in the uterine wall and bulge outward, as well as fibroids that are located laterally next to the uterus, can also be removed this way. All procedures require general anesthesia, and a 2-3 day hospital stay is typical. Physical rest for about 4 weeks is advisable, and only then can physical activities, sauna, or swimming be resumed.

In the so-called myoma embolization, the growths are minimized by closing blood vessels. For this purpose, a thin catheter is inserted into the groin artery under local anesthesia. After a contrast agent is injected to make the blood vessels visible on the X-ray image, the catheter is advanced to the fibroid under X-ray control. Tiny plastic beads are then washed into the blood vessels of the fibroid through the catheter. These beads block the vessels and thus block the blood supply.

The procedure takes between one and two hours, after which bed rest is recommended for at least eight hours to allow the puncture site in the groin to close. A few weeks after the procedure, an MRI is used to check whether the blood supply to the fibroid has been completely stopped and if it has regressed.

In the newer MRI-guided, high-intensity focused ultrasound therapy, uterine fibroids are heated and destroyed by focused ultrasound. Using magnetic resonance imaging, the ultrasound can be directed precisely at the fibroids. Initial studies suggest that fibroids can be effectively treated with it and with less burden than surgery.

Another therapy option is the method of transcervical radiofrequency ablation with intrauterine ultrasound guidance (TRFA). Here, the fibroids are localized using an ultrasound probe inserted into the uterus through the vagina and shrunk by administering radiofrequency energy.

In the wish of Fertility preservation medication therapy can also be considered. For example, progestin-only preparations such as gonadotropin-releasing hormone (GnRH) can be used. They can be applied for up to 6 months and reduce existing fibroids during this period.

Hysterectomy (removal of the uterus)

For certain diseases or deformities, the uterus must be surgically removed. A distinction is made between complete hysterectomy or supracervical hysterectomy, in which the cervix is preserved. Removal is done either through an abdominal incision, a laparoscopy, a laparoscopically assisted vaginal hysterectomy (LAVH), or through the vagina.

When the uterus is removed through the vagina, it is called a vaginal hysterectomy; this generally means a shorter recovery time, less stress, and fewer complications for the patient. However, a prerequisite for this procedure is that the uterus is not too large to be removed through the vagina.

In the minimally invasive laparoscopic hysterectomy, small incisions are made in the abdominal wall, through which surgical instruments and a camera are introduced into the abdomen. The uterus is then shredded and the tissue carefully suctioned. In the first 4-6 weeks after surgery, you should not lift heavy objects or engage in competitive sports. Also, visiting public pools should be avoided to prevent ascending infections or wound healing disorders.

In abdominal section is similar to cesarean section a vertical abdominal incision in the area of the pub hair limit. The uterus is then detached from surrounding structures and removed through the incision before the abdominal wall is closed in layers at the end of the operation. Drainage is placed, if necessary, to allow wound fluid to flow out. The procedure is performed under general anesthesia and requires a stationary stay of at least 4-6 days in which not only pain therapy is continued but also wound healing and urinary excretion as well as intestinal activity are checked.

The recovery phase after a total hysterectomy usually takes around 6 weeks. During this time, no sports should be performed; swimming or bathing is not advisable during this time. After a complete removal of the uterus, menstrual bleeding no longer occurs and pregnancy is impossible.

There are basically three forms of uterus removal: In partial (supracervical) hysterectomy, only the uterine body is removed, but not the cervix. In total hysterectomy, the entire uterus, including the cervix, is removed. In radical hysterectomy, the body and cervix of the uterus, as well as the upper adjoining part of the vagina and parts of the surrounding connective tissue in the pelvic space (parametrium) and adjoining lymph nodes, are removed.

Ovarian cysts

Ovarian cysts are liquid-or tissue-filled cavities in the ovaries. They are surrounded by a capsule, usually the size of a cherry and often arise from hormonal changes during puberty or the menopause. Ovarian cysts are usually benign, rarely cause discomfort and recede within a few months. Most women do not notice ovarian cysts because they are not noticeable. However, they can sometimes cause dull pain in the lower abdomen or cycle disorders like spotting or a Absence of menstruation cause.

If the cyst ruptures, it can be felt as a sudden pain, but is usually harmless. Very large cysts, on the other hand, can press on the bladder or the intestines - the consequences are abdominal swelling, a feeling of pressure, problems urinating or constipation. They rarely become so large that they cause severe discomfort. It becomes more dangerous if an ovary twists around its stem, which can happen especially with larger cysts. A twisted stem leads to severe pain, and the blood supply to the ovary can be interrupted. Then, a quick operation is necessary to prevent the ovary from dying.

Treatment of ovarian cysts

As long as there are no or only mild symptoms, you can wait to see if the cyst regresses on its own. Regular check-ups with the doctor are still important. If the cyst changes, does not regress, or there is suspicion of cancer, laparoscopy is performed. This allows the cyst to be examined more closely and removed if necessary.

Ectopic pregnancy

A PregnancyPregnancy that implants outside the uterus is referred to as an ectopic pregnancy. In a normal pregnancy, the egg is fertilized by the sperm in the fallopian tube. The resulting embryo moves through the fallopian tube and reaches the uterus 3–4 days later. However, if the fallopian tubes are blocked or damaged and cannot transport the embryo to the uterus, the embryo implants in the fallopian tube, resulting in a tubal pregnancy.

Since the fallopian tube cannot nourish the growing embryo like the uterus, there is a risk that it will rupture and bleed after a few weeks, leading to a potentially life-threatening situation. In many cases, women have not yet noticed their pregnancy by this point.

Treatment of an ectopic pregnancy

In most cases, the ectopic pregnancy is ended by laparoscopy. A camera is inserted through the navel, and the surgical instruments are introduced through two other small incisions in the lower abdomen. After the laparoscopy, patients can usually go home the next day and resume their normal activities after about a week. The advantage of this minimally invasive method is the shorter operation time with less blood loss and smaller wounds, allowing for quicker healing and less wound pain after the procedure.

An operation using a laparotomy is only performed if laparoscopy is not possible for technical or medical reasons. After laparotomy, the patient can leave the clinic about 5 days after the operation and usually return to work a few weeks later, depending on the extent of the surgery.

There are two options for removing the ectopic pregnancy: In a salpingotomy, the fallopian tube is preserved, and only the pregnancy tissue is removed through a small incision in the fallopian tube wall. In a salpingectomy, however, the entire fallopian tube along with the pregnancy is removed. This is necessary in situations where the fallopian tube has been completely destroyed by the pregnancy and/or the bleeding cannot be stopped.

Bleeding disorders in women

Unexplained bleeding such as very heavy menstrual bleeding, intermenstrual bleeding, or bleeding after the Menopause should be clarified by a specialist.

Treatment of bleeding disorders

In therapy, hysteroscopy and performed curettage play a significant role. During endoscopy, the diseased tissue is targeted and removed with an electric loop under video control, while in so-called curettage, the uterine lining or other tissue is removed from the uterine cavity and the cervix. Incidentally, this is one of the most common procedures in gynecology.

Curettage can be performed under general anesthesia or short anesthesia or in twilight sleep. The procedure can also be carried out under regional anesthesia. This guarantees freedom from pain, while the patient experiences everything - something that many women do not want. Which Type of anesthesia is ultimately used depends, among other things, on the reason for the procedure being carried out.

A sharp, spoon-shaped instrument - the so-called curette - is used for the curettage, with which the uterine lining is carefully removed. The procedure takes about 15-30 minutes. As a result of the curettage, there may be slight abdominal cramps lasting 1-2 days; slight bleeding afterward is also possible. The usual daily routine can be resumed after 2 days. To prevent further bleeding or possible infections, it is advisable to refrain from sexual intercourse and the use of tampons for a while.