In surgery, the term "enucleation" [Lat. Ex (from) + nucleus (nucleus)] means a kind of surgical intervention for the total removal of rounded formations (cysts, tumors) or organ-encased organs.
The technique of enucleation presupposes the extirpation of the neoplasm without damaging the integrity of the walls of the capsule bounding it and excising (excising) surrounding tissues. And in cases of enucleation of the whole organ, the operation must be carried out without dissecting its shell.
Indications for the procedure
The main indications for enucleation include the presence of small benign tumors with localization in the mammary glands (fibroadenoma, lipoma), prostate gland (prostate adenoma), bartholin, thyroid gland, as well as single nodal myometrium (muscular layer of the uterus) in women of childbearing age.
To date, enucleation is the method of choice for parovarial cysts and ovarian teratoma; retention cysts of the vagina and cervix; nonparasitic cyst of the liver or spleen; cystic formations in the mammary gland (see - Treatment of the cyst of the breast ); a sebaceous gland cyst (see - Removal of an atheroma ); in dentistry - with gingival cysts.
Enucleation of the whole organ is most often performed in ophthalmic surgery for severe traumatic (penetrating) injuries of the eyeball, as well as for a malignant eye tumor (retinoblastoma or uveal melanoma).
It should be noted that in surgical terminology, there are options for determining the enucleation of formations and organs. So, synonymous with the use of definitions - cyst excision and enucleation of the cyst (ovary, breast, etc.). For the isolated removal of cystic lesions, in which adjacent organ tissues are preserved, the term "cystectomy" is also used.
In addition, we can talk about the identity of terms: the laparoscopic method of removal, that is, through small incisions - by laparoscopic access to the organ - using the optical instrument of the laparoscope, and the endoscopic method (since the same endoscope, introduced by laparoscopy) is used in the operation. You can also find the name of the operation - endoscopic vyluschivanie. In any case, the surgeon performs the operation with special tools, looking at the monitor.
Today, laser enucleation is also carried out with the help of short-wave lasers, including neodymium and holmium lasers. Specialists assure that laser enucleation is an effective low-traumatic method of removing clearly localized and delimited benign tumors and cystic formations, which ensures a successful result with minimal blood loss and rapid healing.
Technique of the enucleation
Enucleation of the eyeball
The removal or enucleation of the eyeball can be performed when it is impossible to excise a large-sized cancer of the eye, accompanied by the intolerable pain of the terminal stage of glaucoma (the vision in the diseased eye is already lost), and also if it is impossible to save the eye due to severe injury or injury.
Enucleation of the eyeball is usually performed under general anesthesia and lasts on average no more than 1-1.5 hours. Immediately after the eyeball has been removed, an orbital implant of a slightly smaller size is placed in the orbit than the eyeball. This allows you to maintain the tone of the eye muscles and to facilitate further ophthalmologic prosthetics.
The standard of surgical treatment of most benign ovarian cysts is the enucleation of the ovarian cyst, in which the opening and aspiration of its contents is not performed, but the entire formation is removed directly. In this case, the tissues surrounding the cyst are not affected. Enucleation has the advantage that the whole sample is sent for urgent histological examination, so that the oncology can not be missed.
One of the most common ways of enucleation of the ovarian cysts is laparoscopic surgery - see more details Laparoscopy of the ovarian cyst. Among the advantages of such surgical intervention are a low level of invasiveness and rapid postoperative rehabilitation: a few hours after the operation, patients can get up and move, an extract from the clinic takes place on the second-third day, and the limited regime lasts no more than a month.
The doctors note that the enucleation of the ovarian cyst without opening the capsule ensures that its contents do not enter the abdominal cavity. This is especially important in the presence of dermoid and mucinous cysts, as well as papillary cystoadenoma. And this surgical method avoids serious complications in the future.
Enucleation of breast fibroadenoma
Emaciation or enucleation of the mammary fibroadenoma - along with sectoral resection - is the main surgical method for the removal of benign fibroepithelial lesions of the mammary glands.
A prerequisite for enucleation is the small size of the neoplasm and the histological confirmation of its good quality, which the doctor receives after a cytological examination of the biopsy specimen taken with the help of puncture aspiration of fibroadenoma.
Enucleation of the fibroadenoma of the breast is most often performed under local anesthesia, and the total duration of the operation does not exceed 45-60 minutes. The place where the dissection of the breast is made depends on the location of the formation, but paraareolar access, that is, at the border of the surrounding nipple of the pigmented area (in the sector where the fibroadenoma is located) is most often used. Enucleation techniques include dissection of the gland, removal of the mobile tumor to the site of dissection, separation of nearby tissues (without damaging them with sharp instruments), removal of the formation, suturing.
Patients after this operation are in the clinic for no more than a day, and the stitch is usually removed on the fifth day (if there is no inflammation). But the operated breast can be ill for two or three months. Read also - Removal of fibroadenoma of the breast
Enucleation of myomatous nodes
To date, the enucleation of myomatous nodes (myomectomy) can be carried out in several ways, depending on their location and quantity.
At several large sites it is more expedient to do a laparotomy - with a dissection of the abdominal cavity wall (cut length 9-12 cm), several dissections of the uterine wall and enucleation of all myoma nodes. Recovery after surgery lasts up to two months; complications after enucleation with open access are the bleeding and the formation of adhesions, and the long-term consequences may be associated with a greater risk of uterine rupture in late pregnancy.
The technique of enucleation with laparoscopically accompanied by abdominal myomectomy (with bilateral occlusion of the uterine artery to control blood loss) is most suitable for patients with very large myomatous nodes located in the muscle of the uterine wall (intramural) or in the internal mucosa (subserosely), as well as serous fibrous nodes on the stem. Access is via a cut (about 4 cm in length) along the bikini line, as well as an additional incision (up to 6 mm in length) below the navel.
During visualized laparoscopic intervention, provided that the unit is single, small (3 to 7 cm) and has a subserous or intramural location, the surgeon, after general anesthesia, makes four laser incisions of 1.5 cm in the abdominal region. Enucleation of myomatous nodes (after they are pulled up to the site of dissection) is made by a dissector, and the excreted formation by the morcellar is removed through the incision. The rehabilitation period after such an operation does not exceed ten days.
Hysteroscopic enucleation of myomatous nodes is indicated when they protrude into the uterine cavity, but their size does not exceed 5 cm. This endoscopic instrument does not require incisions and is inserted into the uterus (under general anesthesia) through the vagina and cervix. Nodes are hooded by an electric current, and then removed from the uterine cavity.
Recovery of patients after surgery occurs within three to four days, and possible complications after enucleation with a hysteroscope include bleeding, scarring and adhesions, perforation of the uterus.
Thyroid gland enucleation
Intracapsular enucleation of the thyroid nodule is carried out if a pathological formation is found in the unchanged parenchyma of the gland, which disrupts the functioning of the organ. The technique of enucleation of the thyroid nodule includes a cut up to the capsule of the gland and its removal from the bed to the field of the operating field.
Blood vessels above the node are clamped, the capsule wall is cut, the tissue strands around the knot are grasped and cut, the knot is squeezed into the formed hole and pulled out with scissors. The incision on the capsule is sutured, then the external incision is also layer-by-layer.
In domestic thyroid surgery, intracapsular enucleation is considered a method that maintains the healthy cells of the organ to the maximum extent. Western experts believe that with regard to all suspicious thyroid nodules (including cysts), it is best to use a minimally invasive endoscopic hemithyroidectomy, that is, completely to remove the portion of the gland in which the node was formed. This is associated with a greater risk of malignant neoplasms of this localization.
Enucleation of the prostate and prostate adenoma
Enucleation of the prostate in the case of its benign hyperplasia is accomplished by excising a part of the organ with bipolar vaporezection with a special loop electrode with access through the urethra or using a holmium laser (HoLEP).
Laser enucleation of the prostate can more accurately remove the entire part of the prostate gland, which can block the excretion of urine. In addition, this enucleation method retains the removed tissue of the gland for histological examination necessary to exclude prostate cancer.
Laser enucleation technique: with the help of an endoscope, the surgeon sees which tissues need to be removed, and laser extracts them, leaving only a capsule in place; The excised tissue is transferred to the bladder, and then a morcellation device is used to grind and remove the tissue.
In the same way, under general anesthesia, laser enucleation of the prostate adenoma is performed. The operation allows to completely remove all adenomatous tissues, minimizing the risk of damage to healthy prostate tissue and the need for future re-treatment; provides rapid relief of symptoms and recovery of patients.
Although there are complications after enucleation of the prostate gland and prostate adenoma, which can be expressed in problems with urination, hematuria, genitourinary infections and impotence.
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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