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For a long time, all major operations in gynecology were performed in 2 ways: abdominal - by dissection of the anterior abdominal wall, and vaginal - surgery through the vagina. Endoscopic methods have become widespread throughout the world since the late 1990s and early 2000s. These methods, based on the use of special optical systems, allow you to look inside (abdomen, uterus) and with minimal trauma and the greatest effect to solve the problem. Today, open abdominal surgeries in gynecology are performed very rarely: only in exceptional, rare cases. The "classic" scraping of the uterine cavity has been completely replaced by the hysteroscopic method, which is more efficient and high-quality.

Plastic surgery continues to improve, new, more effective methods of labia plastics are used. Treatment of vaginal prolapse, in some cases, is performed laparoscopically, vaginal access is improved, widespread use of mesh implants (TVT-o system in the correction of urinary incontinence, the use of mesh tape in pectopexy, promontofixation, sacrospinfixation).

This section will present the basic operations performed by the doctor hysteroscopic, laparoscopic, vaginal access. There remains a small percentage of surgeries performed with open abdominal access when laparoscopy is virtually impossible or impractical.

Individual approach to each patient and the ability to create comfortable conditions in the hospital allow
achieve the maximum effect of the treatment

Today, hysteroscopy is the main method of diagnosis and treatment of pathology of the uterine cavity. Also, this method is widely used in the examination for infertility.

Hysteroscopy is performed by introducing an optical system into the uterine cavity, which allows you to assess the condition of the endometrium, detect its changes, take a fragment of the endometrium for examination, assess the walls of the uterine cavity. For this purpose, it is possible to use ultra-thin hysteroscopes, which allows surgery without dilation of the cervical canal: without injury. Operations are performed under both general and local anesthesia.

Examples of operations and interesting clinical cases:


In modern operative gynecology, laparoscopy has almost completely replaced open surgery. Operations no longer require an incision of the anterior abdominal wall (abdomen), are performed through 2-4 punctures, with minimal trauma and much better results. The use of modern instruments and optical systems allows, in some cases, to reduce the length of stay in the hospital to 1 day.

Laparoscopy is widely used in the treatment of infertility to check and restore patency of the fallopian tubes, dissection of the dense protein shell of the ovary in polycystic ovary syndrome and anovulation. In the treatment of leiomyoma, the method of temporary compression of the uterine arteries has been introduced into practice, which allows to remove large nodes effectively and with minimal blood loss, to fully suture the bed after removal of the node. A revised approach to the treatment of endometriosis. Removal of endometrioid cysts is performed with maximum preservation of healthy ovarian tissue, which was achieved with the use of special mannes clamps, subcapsular introduction of remestip, finding the "right" layer for exfoliation of the cyst. The use of mesh implants has significantly improved the treatment of apical prolapse.

Laparoscopic surgery for various gynecological pathologies:

Vaginal surgery

Many gynecological surgeries are performed from the vagina. These interventions are performed on a gynecological chair (operating table in the form of a gynecological chair). First of all, it is operations on the omission or loss of the walls of the vagina and uterus, which include anterior and posterior plastics of the vaginal walls (anterior, posterior colporrhaphy and levatoroplasty), sacrospinal fixation. It is possible to remove the uterus by vaginal access.
Reconstructive operations for congenital anomalies of the genital organs: the septum in the vagina when doubling (complete and incomplete) vagina, operations to form the vagina in its congenital absence (vaginal aplasia).
Surgery on the cervix: restoration of the cervix with severe postpartum ruptures and deformities of the cervix, coagulation (radiowave, laser), conization or trachelectomy in dysplasia and early stages of cervical cancer.
Vaginal surgeries can also include plastic surgery on the labia to correct their size and shape. Surgery for opening the hymen (defloration) or operations to restore innocence.

Open surgery

As before, in operative gynecology there is a place for open surgery. Basically, these operations are performed in advanced forms of the disease. In giant uterine leiomyomas, when laparoscopic access is not possible or not appropriate. With a number of cancers, although today the possibilities of laparoscopy are expanding, and open surgery is performed much less frequently. At complications during laparoscopic operations (massive bleedings) transition to open surgery is possible.

In most cases, surgical access is performed in the lower abdomen along the line of the panties (Pfannenstiel access). The integrity of the anterior abdominal wall is restored in layers with resorbable thread. At the end of the operation, the integrity of the skin is restored by intradermal suture, which allows you to achieve the best cosmetic results.