Surgery to remove the cervix

Surgery to remove the cervix is indicated to women in the case that there are laboratory confirmations of non-invasive cancer. This disease affects only the cervix, and the regional lymph nodes and neighboring organs are not damaged. The only way out is to completely remove the altered cells of the mucous membrane in order to avoid the progressive development of the tumor.

When surgical intervention removes a cone-shaped fragment of the surface of the neck, as well as part of the cervical canal. The remote site undergoes a careful study (laboratory study) in order to identify atypical (degenerating into cancer) cells. Surgical removal of the affected tissue is also necessary if a woman detects cervical erosion, which, if not properly treated, can "degenerate" into cancer. In modern medicine, a radiowave method is used (radio-knife), which allows you to quickly and painlessly remove the affected area of the mucosa.

Before the surgery, a woman is examined, she is given a biopsy, as well as a computer and magnetic resonance imaging. According to statistics, the removal of the cervix to date - one of the most common operations. For example, in America, it takes the second place after an operation for caesarean section. Naturally, the gynecological operation is carried out strictly for medical reasons.

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Indications for an operation to remove the cervix

Surgery to remove the cervix is indicated in those cases when pathological sections are found on the mucosa that cover part of the cervical canal. Such changes may concern many conditions that require intensive care and the following diagnostic actions.

Indications for an operation to remove the cervix are both minor cell pathologies (erosion) and an obvious tumor (cancer). To diagnose the disease, a PAP test is often used, i.e. A cytological smear for the detection of abnormal cells, with the help of which it is possible to reveal in time both precancerous and cancerous changes in the cervical tissues. Such a study is recommended to be done annually for all women, especially those who are at risk. For example, in the detection of stage II-IV dysplasia of the cervix, there is reason to talk about a pre-tumor state, when the cells become atypical, i.e. Acquire other functions that are not peculiar to them. Dysplasia is dangerous because it often occurs without severe symptoms, which is a health hazard. If the disease is not diagnosed in a timely manner, the cancer of the uterine neck can develop.

Consider the indications for the use of specific methods aimed at excising the cervix in the detection of dangerous pathologies.

• Knife amputation is indicated in case of detection of the first stage of cancer. The operation is performed using a scalpel and involves excision of the cervix with subsequent removal of its site, as well as parametric fiber and the upper part of the vagina. The advantage of this method is the complete safety of the woman's reproductive function.
• Radio wave conization is used in the diagnosis of severe diseases, such as dysplasia or cancer. To remove the damaged organ, special instruments are used: a diathermoelectrosurgical apparatus and an electrode (Geimsa-Rogovenko), with which it is possible to easily adjust the length of the radio wave in accordance with the anatomical features of the cervix. It should be noted that this method has contraindications: pathology of organ structure, acute inflammatory process, leukocytosis, etc.
• Laser amputation (used for dysplasia or benign education). The surgeon cauterizes the area where the tumor is localized. Over time, this place is formed scar tissue.
• Cryodestruction (the affected area of tissue is exposed to liquid nitrogen, under the influence of low temperature, cell membranes are destroyed, and tissues die off). This method is contraindicated in the inflammatory process and endometriosis.
• Ultrasonic amputation (almost the same as laser amputation, the only difference is that ultrasound is used to remove tissues).
• Radiosurgical method (radio waves have destructive effect on cells) using the US device "Surgiton" - is considered the safest and most effective method.

In the postoperative period the patient is under the supervision of medical personnel. She is prescribed painkillers and antibiotics. After discharge, minimize physical activity, refrain from taking hot baths, and sexual intercourse.

Preparation

Surgery to remove the cervix is performed according to the testimony of a gynecologist, when a woman has such serious pathologies as erosion, non-invasive cancer, chronic endocervicitis. Before the surgery, you need to undergo a full medical examination, i.e. To pass blood tests (general, biochemical) and urine, as well as biopsy and colposcopy. If necessary, the patient is assigned ECG, ultrasound of the pelvic organs, examination of smears for the presence of atypical cells and other additional studies.

Preparation for the operation begins several days before the appointed date, and if the patient has chronic endocervicitis, then conservative treatment is carried out: vaginal baths, douching and tampons with the use of medicinal solutions.

Immediately before the procedure itself, the mucus is removed from the cervical canal using a probe wrapped with sterile gauze or cotton wool previously moistened with a 10% solution of soda. Then the cervical canal is smeared with iodine tincture. Of the preparatory manipulations should also be noted sanitary treatment: hair removal from the pubic region, hygienic shower and cleaning of the intestine (within 2 days the patient takes a laxative).

To date, doctors have resorted to several methods of performing operations to amputate the cervix:

• cold knife conization;
• cone electroexcision;
• ultrasonic amputation;
• cryodestruction;
• radiosurgical method;
• laser amputation.

In the preoperative period, the woman undergoes psycho-preventive training, and also takes medications (hypnotics and sedatives). More intensively planned preparation takes place in a hospital (within 1-3 days). An anesthesiologist is consulted, a number of studies that have been performed out-patiently (coagulogram, blood test) are repeated, and an optimal method of anesthesia is chosen. In each case, preoperative preparation is determined by the size of the operation and the patient's condition.

Techniques for conducting

Surgery to remove the cervix takes an average of 15-30 minutes, all depends on the severity of the pathology and the forthcoming scope of work. The following operations can be performed on the cervix: cryodestruction and conization, polyp removal, diathermoeccosis, diathermocoagulation, as well as amputation and plastic surgery.

The technique of the operation depends on the chosen method. For example, with radio wave conization, a colposcope, a diathermoelectrosurgical apparatus, and an electrode are used. Initially, the neck surface is anesthetized (local anesthesia is performed). Then, at a distance of 3-5 mm from the affected area, the electrode loop is fixed and a high-frequency alternating current is sent, resulting in the removal of the abnormal tissue region. In order to prevent postoperative infectious exacerbation, the patient is prescribed antibacterial and restorative complexes.

When laser vaporization is carried out sanitation of the vagina, which provides for the complete removal of mucus from the cervical canal. Pain sensations are blocked by intracervical anesthesia. For this purpose, a solution of lidocaine and epinephrine can be used. In some cases, the operation can be performed without the use of anesthesia. To mark the operating field, the doctor uses Lugol's solution. The colposcope is used to visualize and control the operation of the laser. The power value is 20-25 W, the beam diameter can reach up to 2.5 mm. The effect of the laser on the tissue starts from the posterior lip of the uterine neck, the depth of penetration of the laser beam depends on the tissues to be treated. So, when irradiating the cervical canal, this figure can be 7 mm.

Cone-shaped amputation is performed in the presence of hypertrophy or anatomical deformities of the cervix. The technique of the operation is as follows. With the help of gynecological mirrors, the vagina is opened, after which a part of the neck is grasped by forceps and released downward. Then a circular mucosal dissection is performed, approximately 1 cm above the pathological tissue. Using a scalpel, the tissue is conically dissected and removed. After this, V-shaped seams are applied, and the uterine neck cervix is formed.

The wedge-shaped removal of the cervix is indicated by the detection of ectropion (eversion of the mucosa). At the beginning of the operation, the vaginal part of the uterine neck is opened from different sides of the canal, the depth of which will depend on the expected volume of amputation. A wedge-shaped excision of the anterior lip of the neck is performed, after which its edges are sewn by separate sutures. Similar manipulations are carried out with the posterior lip of the neck, including its suturing with special catgut sutures. Then lateral seams are applied, and the permeability of the cervical canal is checked by a probe.

It should be noted that in the postoperative period such unpleasant consequences as pulling pain and spotting can occur, which on average last up to 20 days and do not signal a danger. After vaporisation of the cervix, a woman should refrain from sexual intercourse for at least one month. Reliable results of the analyzes (colposcopy, scraping for cytology and a test for the detection of HPV) will be ready about two months after the surgical intervention.

Cervical surgery to remove the cervix

Surgery to remove the cervix can be cavitary, i.e. Performed when removing the uterus itself, if a woman is diagnosed with uterine cancer. The word "cavitary" means that the operation will be performed directly on the organs themselves, located in the abdominal cavity. The danger lies in the fact that during such operations, protective barriers are violated, which requires special measures to comply with the rules of antiseptic and aseptic.

A hollow operation to remove the cervix often occurs when there is a need to remove the uterus from a tumor of large size, which can not be removed by another method. Accordingly, the whole organ is removed, along with the affected areas, including the cervix. Unfortunately, with this type of operation there is a strong loss of blood, which increases the risk of infection in the postoperative period. Rehabilitation after a lumbar operation is long and an average of 6 weeks.

With regard to the algorithm for performing a cavitary operation, it includes general anesthesia, which provides complete immobility and anesthesia during the procedure. In the absence of contraindications, the patient is given general anesthesia. Then, the stages of surgical access to the organ, manipulation of the damaged organ and tissues, wound suturing (layer-by-layer closure) are consistently performed. The seam will remain in place (vertical or horizontal), approximately 20 cm long. For better tissue healing, a woman is recommended to wear a postoperative bandage.

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How long does it take to remove the cervix?

Surgery to remove the cervix is performed when a pathological process is identified that requires immediate surgery. It can be follicular hypertrophy, chronic endocervicitis, ectropion, a tumor (cancer) and other pathological processes.

How long does it take to remove the cervix? Many women who are preparing for surgery are interested in this issue. The answer to it will be different in each case. The duration of the procedure depends on the anesthetic maintenance used, the age and individual characteristics of the female body, the diagnosis of the disease, as well as the degree of its severity, the surgeon's qualification and a number of other factors.

On average, the time of such an operation is 10-15 minutes, but with diathermic excision of the cervix - a little more, which is due to careful preparation of special equipment and the patient herself. The operation to remove cervical polyps lasts only a few minutes and does not require a long period of rehabilitation. Amputation of the uterine neck through vaginal access lasts about 1 hour, hysterectomy - a little longer, removal of the uterus with appendages can take from 1 to 2 hours, which is explained by the significant volume of the operation.

If we talk about cases associated with a malignant tumor, the operation can last several hours. Everything depends on the expected volume of surgical intervention, the need to take material for histology and other tests, possible complications during surgery, and so on.

Effects

Surgery to remove the cervix can have negative consequences, which arise as a result of various complications. First of all, it should be noted the risk of repeated surgical intervention due to bleeding caused by mechanical damage to the mucosa with the use of surgical instruments or inadequate hemostasis. In this case, it becomes necessary to duplicate the operation.

Consequences may concern infectious complications: the development of sepsis, peritonitis and suppuration of hematomas. In the post-operative period, a woman may experience vaginal bleeding and necrosis of the vaginal dome. It is also possible the development of a disease called "endometriosis", in which cells of the uterine mucosa can be found in other reproductive organs.

Consequence of radio wave conization of the cervix are spotting before menstruation. In rare situations, such procedure becomes an obstacle for conception and further bearing of the child due to adhesions and seams arising after the operation. If conization is performed with a laser, the risks of negative consequences are minimized. Successful operation of cervical amputation will not affect the reproductive function of the woman in the future.

With repeated conization, problems of miscarriage at early stages, premature pregnancy, or inability to conceive a child can arise. However, this is rare.

Complications after an operation to remove the cervix

Surgery to remove the cervix is often accompanied by various complications, which are associated with bleeding, purulent infections, sepsis. In rare cases, when an unskilled doctor conducts the operation, complications such as vaginal canopy necrosis may develop. To avoid unpleasant consequences, the gynecologist appoints a woman for a scheduled examination. So, after two weeks after the operation, you should make sure that the rehabilitation runs smoothly. It is very important that every woman who survived the cervical amputation surgery visited the gynecologist at least once every 3 months for the purpose of examining and regularly delivering a vaginal secretion for a cytological examination.

Complications after the operation to remove the cervix can be of different nature. Below are the most common ones.

• Bleeding from the vagina (operating wound). Usually observed in the first hours and days after the operation, most often - because of unsuccessfully performed hemostasis.
• Damage to the bladder. It occurs with high amputation of the uterine neck due to improperly executed techniques in the individual stages of the operation (incision, suturing, etc.).
• Narrowing or closing of the cervical canal. This complication can occur during the application of stitches, so the permeability of the neck canal must be checked by a probe.
• Damage to the peritoneum of the rectum pocket during excision of the cone due to the negligence of the surgeon.

In addition, during the application of stitches to the rigid tissues of the uterine neck, the surgical needle may break, and its fragment will remain in the tissues. This leads to unnecessary trauma to the tissues, so it is important to use strong needles that are of sufficient length.

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Rehabilitation period

Surgery to remove the cervix is carried out under stationary conditions and requires the use of special medical equipment and instruments. In the first hours after surgery, the patient will be monitored by the medical staff. Then she will be transferred to a regular ward and prescribed painkillers for pain relief. To prevent the possible development of infections, antibacterial agents are used. On average, a woman can stay in the hospital for 6-7 days - all depends on the success of the rehabilitation, the presence or absence of complications, the general well-being of the patient.

The rehabilitation period can be accompanied by such unpleasant sensations as fatigue, dizziness, weakness, general malaise, pain, etc. Therefore, a woman needs to minimize physical activity as much as possible and return to her usual life gradually.

For 6 weeks, you should abstain from sexual contact and taking contraceptives, and avoid water procedures (swimming, taking baths, etc.). Do not use hygienic tampons to avoid infection of the wound. Usually, in the first week after the operation, a bloody discharge of dark brown color is observed in the woman. If they acquire a different shade and become more abundant, you need to urgently consult a gynecologist. On average, the rehabilitation period lasts for 4-6 weeks, after which it is possible to return to work and the usual way of life.

Surgery to remove the cervix is a serious procedure that requires a special approach and the selection of optimal methods aimed at eliminating pathology and complete recovery of the woman. 2 weeks after surgery, it is necessary to visit a gynecologist for examination. Next time, the doctor will take a smear for cytological examination, and also perform colposcopy and magnetic resonance imaging. For 5 years, a woman must undergo a gynecological examination every 3 months.