Obstetrics and Gynecology Disease：Gynecological Operation

• Two ways approach: from abdominal area and from vagina

Two ways approach: from abdominal area and from vagina

As an approach of gynecological operation, they are divided into two groups, one is an approach from abdominal area, the other is from vagina.An approach from abdominal area is then divided into abdominal operation and laparoscopic operation. Abdominal operation is, as known from its name, cut abdominal area for 10cm or more and surgery is conducted. Surgery is made by lower abdomen transverse incision or median longitudinal incision. Whether operation is done by transverse incision or longitudinal incision is decided by the size of the disease or resected object. For the cancer surgery, it commonly made by longitudinal incision.

For laparoscopic operation, camera named as laparoscope is inserted from umbilicus, and surgery is conducted with several holes created on abdominal area. Because of the cut is small, early hospital discharge and social rehabilitation are possible.laparoscopic surgery basically targets benign disease such as Leiomyoma or ovarian cystoma, and for early stage of the cancer of uterine body, it is limited to pelvic lymph node dissection, but it becomes subject to health insurance for the facility fulfilled the standards from 2014.

There are several kinds of surgery available in the surgical operation from vagina (vaginal surgery). It is possible to make hysterectomy by vaginal surgery. Cervical dysplasia and conization in which partially extract only the neck of uterus in cervical squamous intraepithelial neoplasia. In Uterine Mirror Surgery using the endoscope named as hysteroscope, it can extract leiomyoma or polyp on the internal side of uterus. There is a vaginal surgery where mesh is inserted against the pelvic organ prolapse like hernia uteri or vaginal cystocele, and there is a surgery where vaginal wall is pushed back to origin location with fixing to pelvic ligaments.

Total Hysterectomy (Ventrotomy, Laparoscopically, Vaginal)

Surgery which extract entire uterus out. When necessary, ovaria or oviduct are selectable from total extraction or conservation. If it is benign disease, leiomyoma or adenomyosis are subject to the hysterectomy surgery. In case of uterus cancer, it becomes subject to extraction, semi-radical hysterectomy becomes necessary depend on the disease or condition. Because vaginal stump suture has performed after uterus extraction, it is necessary to refrain from sexual intercourse until the cure at vaginal stump is settled down.

Supracervical Hysterectomy (Ventrotomy, Laparoscopically)

Supracervical Hysterectomy is called as subtotal hysterectomy. With conserving the neck of uterus, main body only is extracted. It targets the benign disease like leiomyoma. The surgery is conducted when hysterectomy is imperative due to postpartum bleeding. The merit of this supracervical Hysterectomy is easier and inexpensive in comparison with hysterectomy. But since the neck of uterus remains, there is a possibility of developing cervical cancer so that health check is necessary.

Enucleate Myomectomy (Ventrotomy, Laparoscopically)

The surgery is to enucleate Leiomyoma only and conserve uterus. Depend on the count and size of myoma, laparoscopic surgery is also possible. Their might increase bleeding when myoma is large or many exist. Therefore, there are the cases where conducting hormone treatment (False Menopause Therapy) is to make myoma small and reducing blood flow to uterus to make bleeding at surgery reduced, conserving own blood before surgery is to prepare for excess bleeding at surgery. To extract myoma intra-abdominally, morcellator, which cut myoma finely, may be used. In case it is a sarcoma, not a myoma, pay attention is necessary for cancer tissue spread across in abdominal cavity.

Hysteroscopic Myomectomy

The surgery to enucleate submucosal myoma jut out inside of uterus using hysteroscope vaginally. Since it does not cut abdominal area, early discharge from hospital is possible. With extracting submucosal myoma, bleeding at menses is reduced, or possible to extract leiomyoma being the cause of infertility. Part of myoma may not be extracted because of the size or jut out condition of leiomyoma.

Semi-radical hysterectomy (Ventrotomy, Laparoscopically)

The surgery is conducted for malignant tumor of uterus, primary for cancer of the cervix. Because of extracting surrounding tissues of cervix of uterus, surgical operation time and bleeding amount are getting longer and larger in comparison with total hysterectomy. Also, surgery might injure nerves to bladder so that risk of developing disorder of urination is getting higher in post operation. The tube named as Foley catheter commonly left remains in bladder for few days after the surgery. After that it is checked whether or not self-urination is possible, and when urination disorder exists, self-catheterization is temporarily necessary.

Ovarian cystectomy (Ventrotomy, Laparoscopically)

The surgery which ovarian cystoma is extracted and conserve ovarium itself. Basically, this surgery is conducted for benign ovarian cystoma. Recently, laparoscopic surgery is primarily conducted. Although this has a merit of conserving ovarium, there is a risk of tumor recurrence exist.

Adnexectomy (Ventrotomy, Laparoscopically)

Surgery to extract ovarium and oviduct. This is conducted for cancer of ovary and ovarian boundary malignant tumor. For the person who do not have a wish for ovarium conservation even with benign ovarian tumor, or the person who is after menopause, and for the person conservation of ovarium is difficult because of giant ovarian tumors, this surgery is conducted. Laparoscopic surgery for the benign tumor is primarily conducted.

Conization

This surgery is partially extracting neck of uterus vaginally against cervical dysplasia or cervical carcinoma cancer. More accurate diagnosis for pathological change of the canal of the cervix can be done by submitting extracted cervical part to pathological examination. For cervical dysplasia or cervical carcinoma cancer, it is possible to treat by total removal. Because canal of the cervix is partially removed, in case patient wishes for pregnancy, risk for cervical incompetence, premature ovarian failure, or threatened premature delivery becomes higher than normal.

Lymphadenectomy (Ventrotomy, Laparoscopically)

To check there is nothing displaced to lymphatic node at the time of cancer of malignant tumor like cervix uteri, cancer of uterine body, or cancer of ovary, extirpative surgery is conducted. Adenectomy is conducted from uterus, pelvic node surrounding uterus, and when necessary, to para-aortic node. When lymphatic displacement is recognized, anti-cancer drug or radiation treatment are commonly done as for postoperative supplemental treatment after surgery.