Enucleation

In surgery, the term “enucleation” [Latin: ex (from) + nucleus (nucleus)] means a type of surgical intervention for the total removal of round formations (cysts, tumors) or organs enclosed in a membrane.

The technique of enucleation involves the extirpation of the neoplasm without violating the integrity of the walls of the capsule that limits it and cutting out (excising) the surrounding tissues. And in cases of enucleation of an entire organ, the operation must be performed without dissecting its membrane.

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Indications for the procedure

The main indications for enucleation include the presence of small benign tumors localized in the mammary glands (fibroadenoma, lipoma), prostate gland (prostate adenoma), Bartholin's, thyroid gland, as well as single nodular formations of the myometrium (muscular layer of the uterus) in women of childbearing age.

Today, enucleation is the method of choice for paraovarian cysts and ovarian teratoma; retention cysts of the vagina and cervix; non-parasitic cysts of the liver or spleen; cystic formations in the mammary gland (see - Treatment of mammary gland cysts ); sebaceous gland cysts (see - Removal of atheroma ); in dentistry - for gingival cysts.

Enucleation of the entire organ is most often performed in ophthalmological surgery for severe traumatic (penetrating) injuries to the eyeball, as well as for malignant tumors of the eye (retinoblastoma or uveal melanoma).

It should be noted that in surgical terminology there are variants of definitions of enucleation of formations and organs. Thus, the use of definitions is synonymous - enucleation of a cyst and enucleation of a cyst (ovary, mammary gland, etc.). For isolated removal of cystic formations, in which adjacent tissues of the organ are preserved, the term "cystectomy" is also used.

In addition, we can talk about the identity of the terms: laparoscopic method of removal, that is, through small incisions - by laparoscopic access to the organ - using the optical instrument of the laparoscope, and endoscopic method (since the same endoscope is used during the operation, inserted by laparoscopy). You can also come across the name of the operation - endoscopic enucleation. In any case, the surgeon performs the operation with special instruments, looking at the monitor.

Today, laser enucleation is also performed using short-wave lasers, including neodymium and holmium. Experts assure that laser enucleation is an effective, low-trauma method for removing clearly localized and delimited benign tumors and cystic formations, ensuring a successful result with minimal blood loss and rapid healing.

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Technique enucleations

Enucleation of the eyeball

Removal or enucleation of the eyeball can be performed when it is impossible to excise a large cancerous tumor of the eye, in the case of terminal stage glaucoma accompanied by unbearable pain (vision in the diseased eye has already been lost), and also if it is impossible to save the eye due to severe trauma 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 slightly smaller than the eyeball is placed in the eye socket. This helps maintain the tone of the eye muscles and facilitates further ophthalmological prosthetics.

More information in the material - Enucleation of the eyeball

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Enucleation of ovarian cyst

The standard surgical treatment for most benign ovarian cysts is enucleation of the ovarian cyst, which does not involve opening and aspirating its contents, but rather removing the entire formation directly. The tissues surrounding the cyst are not affected. Enucleation has the advantage that the entire sample is sent for urgent histological examination, so that oncology cannot be missed.

One of the common methods of ovarian cyst enucleation is laparoscopic surgery – see more details Laparoscopy of ovarian cysts. Among the advantages of such surgical intervention are the low level of invasiveness and rapid postoperative rehabilitation: a few hours after the operation, patients can get up and move around, discharge from the clinic occurs on the second or third day, and the limited regime continues for no more than a month.

Doctors note that enucleation of an ovarian cyst without opening the capsule guarantees that its contents will not enter the abdominal cavity. This is especially important in the presence of dermoid and mucinous cysts, as well as papillary cystadenoma. And this surgical method allows you to avoid serious complications in the future.

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Enucleation of fibroadenoma of the mammary gland

Enucleation or enucleation of fibroadenoma of the mammary gland – along with sectoral resection – is the main surgical method for removing benign fibroepithelial formations of the mammary glands.

A prerequisite for enucleation is a small size of the neoplasm and histological confirmation of its benignity, which the doctor receives after a cytological examination of a biopsy taken using puncture aspiration of the fibroadenoma.

Enucleation of fibroadenoma of the mammary gland is most often performed under local anesthesia, and the total duration of the operation does not exceed 45-60 minutes. The place where the breast is dissected depends on the localization of the formation, but most often the paraareolar approach is used, that is, on the border of the pigmented area surrounding the nipple (in the sector where the fibroadenoma is located). The enucleation technique includes dissection of the gland, removal of the mobile tumor to the dissection site, separation of nearby tissues (without damaging them with sharp instruments), removal of the formation, and suturing.

After this operation, patients stay in the clinic for no more than a day, and the suture is usually removed on the fifth day (if there is no inflammation). But the operated breast may hurt for two to three months. Read also - Removal of fibroadenoma of the mammary gland

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Enucleation of myomatous nodes

Today, enucleation of myomatous nodes (myomectomy) can be performed in several ways, depending on their location and quantity.

In case of several large nodes, it is more appropriate to perform laparotomy – with dissection of the abdominal wall (incision 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 include bleeding and formation of adhesions, and long-term consequences may be associated with a high risk of uterine rupture in late pregnancy.

The technique of enucleation in laparoscopically assisted abdominal myomectomy (with bilateral uterine artery occlusion 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 inner mucosa (subserosal), as well as sero-fibrous nodes on a pedicle. Access is achieved through an incision (about 4 cm long) along the bikini line, as well as an additional incision (up to 6 mm long) below the navel.

During visualized laparoscopic intervention, provided that the node is single, small (from 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 cavity. Enucleation of myomatous nodes (after pulling them to the place of dissection) is performed by a dissector, and the enucleated formation is removed through the incision by a morcellator. 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. The nodes are enucleated with a loop using an electric current and then removed from the uterine cavity.

Patients recover from surgery within three to four days, and possible complications after enucleation using a hysteroscope include bleeding, scarring and adhesions, and uterine perforation.

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Enucleation of thyroid nodule

Intracapsular enucleation of a thyroid gland node is performed if a pathological formation that disrupts the functioning of the organ is detected in the unchanged parenchyma of the gland. The technique of enucleation of a thyroid gland node includes an incision to the capsule of the gland and its removal from the bed into the area of the surgical field.

Clamps are applied to the blood vessels above the node, the capsule wall is incised, the tissue strands around the node are captured and incised, the node is squeezed out into the resulting opening and enucleated with scissors. The incision on the capsule is sutured, then the outer incision is sutured layer by layer.

In domestic thyroid surgery, intracapsular enucleation is considered a method that preserves healthy cells of the organ to the maximum extent. Western specialists believe that for all suspicious thyroid nodules (including cysts), it is best to use minimally invasive endoscopic hemithyroidectomy, that is, completely remove the part of the gland in which the nodule has formed. This is due to the high risk of malignancy of neoplasms in this localization.

Enucleation of the prostate gland and prostate adenoma

Enucleation of the prostate gland in case of its benign hyperplasia is performed by enucleating part of the organ using bipolar vaporectomy with a special loop electrode with access through the urethra or using a holmium laser (HoLEP).

Laser enucleation of the prostate allows for more precise removal of the entire prostate gland that may be blocking urine flow. In addition, this method of enucleation preserves the removed gland tissue for histological examination, which is necessary to rule out prostate cancer.

Laser enucleation technique: Using an endoscope, the surgeon sees what tissue needs to be removed and uses a laser to enucleate it, leaving only the capsule in place; the excised tissue is moved to the bladder, and then a morcellation device is used to chop up and remove the tissue.

In the same way, under general anesthesia, laser enucleation of the prostate adenoma is performed. The operation allows for the complete removal of all adenomatous tissue, minimizing the risk of damage to healthy prostate tissue and the need for future re-treatment; it 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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