Total laparoscopic hysterectomy in patients with large myomatous uterus

Miomi su najčešći benigni tumori maternice. Većinom su miomi asimptomatski te se takvi uglavnom ne trebaju liječiti. Ipak, miomi mogu izazvati obilna krvarenja i uzrokovati sideropeničnu anemiju. Također mogu uzrokovati zdjeličnu bol, dispareuneju te inkontinenciju zbog pritiska na okolne strukture. U takvim se slučajevima miome treba liječiti. Iako se ponekad primjenjuje medikamentno liječenje, jedini trajni način liječenja je kirurški, miomektomijom ili histerektomijom. U ovom smo retrospektivnom istraživanju uspoređivali dvije glavne kirurške metode histerektomije velikih miomatoznih maternica: laparotomiju i laparoskopiju. Laparotomijski pristup je još uvijek najčešći, posebno kod velikih maternica, ali se udio histerektomija izveden laparoskopski kontinuirano povećava zahvaljujući tehnološkom napretku u endoskopskoj kirurgiji općenito, kao i zbog većeg iskustva kirurga. Laparoskopski pristup omogućuje brži postoperacijski oporavak, manji gubitak krvi i manju incidenciju komplikacija. U ovo su istraživanje uključene 33 pacijentice, od kojih je 15 operirano laparoskopskim pristupom, a 18 laparotomijskim tijekom 2016. i 2017 u Klinici za ženske bolesti i porode „Petrova”. Usporedbom dviju skupina, koje se nisu značajno razlikovale s obzirom na dob, paritet, BMI, veličinu maternice te prijeoperacijsku razinu hemoglobina, ustanovljeno je da je u skupini operiranoj laparoskopski vrijeme hospitalizacije bilo znatno kraće te intraoperacijski gubitak krvi manji. Ni u jednoj skupini nisu zabilježene komplikacije.Myomas are the most common benign uterine tumors. Mostly they are asymptomatic and do not need to be treated. However, myomas can cause profuse bleeding thus causing iron deficiency anemia. They can also cause pelvic pain, dispareunea and incontinence due to increasing pressure on surrounding tissues. In these cases myomas must be treated. Even though pharmacological treatment is sometimes chosen, the only permanent solution is surgical treatment, either a myomectomy or a hysterectomy. In this retrospective research we compared two main surgical methods of hysterectomy of large myomatous uteruses: laparotomy and laparoscopy. Laparotomy is still the most commonly used approach, especially in large uteruses, but the laparoscopic approach is becoming increasingly more common thanks to technological advances in endoscopic surgery, as well as increased surgical experience. Laparoscopic approach enables faster postoperative recovery, reduced blood loss and a smaller incidence of complications. This research included 33 patients, 15 of whom underwent a laparoscopy and 18 underwent a laparotomy during 2016 and 2017. The two groups of patients didn't differ significantly in regards to age, parity, BMI, uterine size nor preoperative hemoglobine levels. We have found that hospital stay was significantly shorter in the laparoscopic group. Blood loss levels were also significantly lower in the laparoscopic group. There were no complications in either group