Gynecology. Department of Gynecology Department of Operative Gynecology

Diagnostics and treatment of a wide range of gynecological diseases, including emergency pathology, oncology, are carried out in accordance with international standards using modern medical diagnostic equipment and tools. Modern medicines are used.

In our department, patients with such diseases as uterine fibroids, endometriosis, ovarian cysts, endometrial hyperplasia and polyps, cervical pathology, uterine bleeding of any etiology, inflammatory diseases of the female reproductive system, infertility, ectopic pregnancy, pathology of early terms receive highly qualified medical care. pregnancy. At a high professional level, a variety of surgical interventions are performed in patients with gynecological pathology. Endosurgery is actively used, laparoscopic operations on the uterus and uterine appendages are performed, minimally invasive technologies are widely used: hysteroscopy, hysteroresection.

The department tracked good long-term results of treatment of patients with uterine prolapse, prolapse of the vaginal walls, and urinary incontinence. For the treatment of this group of patients, various methods of surgical interventions, including slings, are used.

In the practice of the department, it is customary to conduct a comprehensive examination of patients to identify comorbidities, consult related specialists and, if necessary, perform combined surgical interventions.

The doctors of the department carry out consultations of patients at the outpatient stage. It is possible to receive recommendations on any gynecological pathology, including the problems of hormonal contraception, hormonal treatment of various diseases, and the treatment of menopausal syndrome.

The department treats oncogynecological patients with any type of oncopathology. Surgical interventions are performed at a high level in accordance with international standards. If necessary, under the supervision of oncologists, chemotherapy and radiation therapy are performed.

All surgical interventions are performed under general anesthesia using modern drugs for general anesthesia. According to indications, epidural or spinal anesthesia is actively used in the anesthetic management complex, also using modern drugs and disposable instruments from leading Western manufacturers. For intra- and postoperative monitoring and life support of patients, the Central Clinical Hospital has equipment that meets the stringent requirements of anesthesiology of the 21st century. The first hours after abdominal surgery until the patient’s body condition is completely stabilized, they are obligatorily observed and treated by resuscitators of a special postoperative department, which excludes the development of complications likely in the immediate postoperative period, provides the necessary and controlled level of anesthesia, respiratory support. All of the above, combined with the high level of training and experience of CCH anesthesiologists, provides patients of the gynecological department with a high level of safety during surgery of any degree of complexity and duration, as well as sufficient comfort in the first hours of the postoperative period.

Diseases treated by the specialists of the department:

• treatment of uterine fibroids of any size;
• oncological diseases of the female genital area of ​​any localization;
• tumors and tumor-like formations of the uterine appendages;
• prolapse of the uterus and vaginal walls;
• stress urinary incontinence;
• external and internal endometriosis;
• uterine bleeding in juvenile, reproductive, perimenopausal and postmenopausal periods;
• hyperplastic processes of the endometrium;
• acute and chronic inflammatory diseases of the fallopian tubes, ovaries with the formation of adhesions and tubo-ovarian formations, leading to infertility;
• bartholinitis and cysts of the Bartholin gland;
• violation of menstrual function;
• complications of pregnancy up to 12 weeks;
• ectopic pregnancy;
• climacteric syndrome;
• neuroendocrine syndromes (polycystic ovary syndrome, adrenogenital syndrome, neuroexchange endocrine, premenstrual and post-castration syndromes);
• selection of hormone replacement therapy;
• insertion and removal of the IUD;
• treatment of diseases of the cervix, condylomas of the vulva and vagina with simultaneous biopsy;
• and much more...

Diagnostics:

• ultrasound procedure;
• colposcopy;
• hysteroscopy;
• laparoscopy;
• fractional scraping;
• mammography;
• hysterosalpingography;
• multislice computed tomography (MSCT);
• magnetic resonance imaging (MRI);
• positron emission tomography (PET).

Complete laboratory diagnosis of inflammatory diseases of the urinary system:

• clinical and biochemical studies;
• hormone research;
• immunological studies;
• taking gynecological smears and scrapings;
• histological and cytological examination of tissues;
• PCR diagnostics of sexually transmitted diseases, including viral infections (HSV, HPV).

Manipulations and operations

All types of abdominal and endoscopic operations, including using sling techniques, as well as termination of pregnancy up to 12 weeks, insertion and removal of IUDs, treatment of diseases of the cervix, condylomas of the vulva and vagina with simultaneous biopsy, intimate plastic surgery and genital surgery.

On the basis of the gynecological departments of the hospital GKB No. 31, a clinic of the Department of Obstetrics and Gynecology of the Russian National Research Medical University has been deployed.

Gynecology City Clinical Hospital No. 31 is rightfully considered one of the best in Moscow. All types of conservative and surgical treatment of any gynecological diseases are used. Hysteroscopic and laparoscopic diagnostics are possible, and surgical treatment using these methods allows to speed up the recovery period as much as possible and is the most gentle for patients.

Since 2004, the modern organ-preserving method for the treatment of uterine fibroids and adenomyosis has been firmly rooted in the hospital - uterine artery embolization.

detailed information

general information

Head of Department No. 1 - Doctor of Medical Sciences, Professor E.N. Kaukhova.
Head Nurse of the Department Yu.N. Tarasova.

Head of Department No. 2 - Ph.D. O.I. Mishiev.
Senior nurse - N.G. Kosolapova.

In two gynecological departments of the hospital, all types of conservative and surgical treatment are successfully applied, including for the following diseases:

• uterine bleeding of the reproductive, perimenopausal periods, menopausal periods;
• diseases of the cervix;
• physiology and pathology of the postmenopausal period;
• intrauterine pathology (uterine fibroids, adenomyosis, endometrial polyps, endometriosis, synechia, foreign bodies);
• ovarian formations in patients of different age periods
• inflammatory diseases of the internal genital organs.

The main types of surgical treatment:

• diagnostic laparoscopy;
• abdominal surgery and laparoscopic operations in the amount of amputation and extirpation of the uterus;
• abdominal surgery and laparoscopic operations on the appendages;
• vaginal extirpations;
• plastic vaginal surgeries, including prolapse of the uterus and prolapse of the walls of the vagina;
• laparoscopic surgery for the treatment of infertility;
• laparoscopic organ-sparing operations in tubal pregnancy; restoration of patency of pipes;
• hysteroscopic treatment of intrauterine pathology;
• electrosurgical, laser and thermal ablation of the endometrium, embolization of the uterine arteries.

The motto of the team of gynecological departments is
warm care for patients.

The clinic receives dozens of letters of thanks. The implementation of high-tech methods is carried out by the doctors of City Clinical Hospital No. 31 in close professional contact with the staff of the department.

general information

• • Head of the Department of Obstetrics and Gynecology of the Pediatric Faculty of the Russian National Research Medical University - Doctor of Medical Sciences, Academician of the Russian Academy of Sciences, Member of the Presidium of the Board of the Russian Society of Obstetricians and Gynecologists, Chairman of the Presidium of the Moscow Society of Obstetricians and Gynecologists, member of the New European Surgical Academy (NESA), member of the International Federation of Obstetricians and Gynecologists ( FIGO)- Kurtser Mark Arkadievich— student of the founder and honorary head of the department — Savelieva Galina Mikhailovna, Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Honored Scientist, Vice President of the Russian Association of Obstetricians and Gynecologists, Head of the Department of Obstetrics and Gynecology of the Pediatric Faculty from 1971 to 2017.
    At the moment, the achievements of the clinic are associated with the implementation of a wide range of laparoscopic therapeutic and diagnostic interventions on the pelvic organs. Over the past 20 years, one of the employees of the department, Doctor of Medical Sciences, Professor Sergei Vyacheslavovich Shtyrov a school of endoscopic gynecology was established on the basis of 31 hospitals.Professor Valentina G. Breusenko- the founder of the hysteroscopic method in the City Clinical Hospital No. 31. At the present stage, with the introduction of hysteroresection, laser ablation and thermal ablation of the endometrium, the arsenal of hysteroscopic operations performed has significantly expanded. Since 2004, the modern organ-preserving method for the treatment of uterine fibroids and adenomyosis has been firmly rooted in the hospital - uterine artery embolization. Over the past 5 years, cooperation with the department has allowed practitioners to defend 4 doctoral and 38 master's theses. Currently, a grant has been received to carry out scientific developments on the topic "Early diagnosis of ovarian cancer." To the staff of the department: Academician of the Russian Academy of Medical Sciences G.M. Savelieva, professors V.G. Breusenko, S.V. In 2003, Shtyrov was awarded the Prize of the Government of the Russian Federation for the development and implementation of endoscopic methods of diagnosis and treatment in gynecology.

general information

Uterine artery embolization (UAE) is one of the modern directions of surgical treatment of uterine diseases, which consists in puncture of the artery on the thigh, catheterization of the uterine vessels and the introduction of particles of a special embolization preparation.

Symptomatic or growing uterine fibroids

• Size up to 20 weeks of pregnancy in the absence of severe pathology of the cervix, endometrium and ovaries.
• In patients interested in pregnancy, with a confirmed role of uterine fibroids in the pathogenesis of infertility or with a high risk of miscarriage, when it is impossible to perform a safe myomectomy.
• As preparation for myomectomy or hysteroresectoscopy.

Intensive uterine bleeding of various etiologies, when other methods of treatment are impossible or are associated with a real threat to the life of the patient.

When determining the indications for UAE for fibroids, the motivation of patients is important: the patient's strong desire to preserve the uterus, avoid surgery, and interest in pregnancy.

Uterine artery embolization (UAE) is performed in:

general information

Robotic surgery is a new, high-tech type of minimally invasive surgery, which consists in surgical intervention through small incisions on the patient's skin and the ability to operate remotely. This ensures minimal trauma, faster recovery, reduces the length of the patient's stay in the hospital, and minimizes the likelihood of further complications.

Benefits of Robotic Surgery

The da Vinci Si robot does not perform operations on its own, contrary to popular belief. But thanks to remote control and high-quality imaging, it allows the operating surgeon to make more precise movements and eliminate hand tremors. That is, the robot follows all the movements of the surgeon, and he is not able to move or program himself.

These factors create ideal conditions for the surgeon and facilitate complex laparoscopic operations. As a result of the maximum precision of even very complex instrument movements, excellent image quality and the ability to operate on small and hard-to-reach areas, the duration of hospitalization of patients is reduced, they feel less pain, lose less blood, have a better aesthetic result, have faster rehabilitation and return to hospital sooner. Everyday life.

Robotic operations in gynecology City Clinical Hospital No. 31

In the 1970s and 1980s, laparoscopy began to be widely introduced into clinical practice, which was associated with the advent of fiber optics and special instruments. As a result, not only the quality of diagnostics has improved, but some interventions on the abdominal organs have also become possible. By the way, in our country, the experience of using laparoscopy in gynecology was summarized in 1977 in a monograph by G.M. Savelyeva, Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, professor and our doctor, under whose leadership the first operation was performed in our hospital after its opening in 1970.

At the moment, almost all gynecological operations are performed using laparoscopy and a robot. Robotic surgery in gynecology is one of the fastest growing areas and is used in the treatment of all benign and malignant gynecological diseases. Our gynecologists perform operations on women with genital prolapse (prolapse), including pelvic floor support (promontofixation using a mesh implant), removal of myomatous nodes (myomectomy) with preservation of the uterus, panhysterectomy with lymph node dissection. Thus, operations that were previously performed laparoscopically can now be reliably performed using a robotic method.

Operation of uterine fibroids and ovarian formations

Today, endoscopic operations are routinely performed regardless of the size of the uterus. Depending on the localization of myomatous nodes and their number, removal can be done with small incisions and without resorting to open surgery. In this case, uterine fibroids, regardless of their size, are removed from the abdomen in small sections using a marcellator.

Radical hysterectomy (removal of the uterus) is a classic and effective method of treating oncological diseases of the uterus and appendages at the initial stage. Robot-assisted surgery makes it minimally invasive, with less blood loss and hospital stay.

Experience in conducting robotic operations in City Clinical Hospital No. 31

At the moment, in City Clinical Hospital No. 31, robotic operations of varying complexity using the da Vinci robotic system are carried out on a regular basis.

Today, gynecological robotic surgeries include removal of ovarian tumor-like formations, myomectomy, promontofixation, total and partial hysterectomy, treatment of endometriosis, as well as treatment of endometrial and ovarian cancer.

general information

Laparoscopy is an endoscopic method of emergency and elective surgery. It allows you to examine the internal organs of the abdomen through a small opening in the abdominal wall. Inspection is carried out using an optical tube. After 2-3 other punctures, the necessary manipulations with the organs are performed. Laparoscopy is practically bloodless and less traumatic.

At the origins of laparoscopic gynecology in Russia is the Academician of the Russian Academy of Medical Sciences, Professor, Head of the Department of Obstetrics and Gynecology of the Pediatric Faculty of the Russian State Medical University Galina Mikhailovna Savelyeva. Every laparoscopy specialist rightfully calls her your Teacher.

The range of surgical interventions performed by laparoscopic access is wide: gynecological operations, cholecystectomy and hernioplasty, gastrectomy, pancreatoduodenal resection and operations on the colon and rectum.

general information

Ectopia of the cervix (also Ectopia of the epithelium of the cervix, Pseudo-erosion of the cervix, Erosion of the cervix, Endocervicosis) - the location of the cylindrical epithelium lining the cervical canal, on its vaginal surface, which looks like a red spot around the outer opening of the canal. Ectopia occurs in about half of women of reproductive age and almost never occurs in women over 40 years of age.

general information

Hysteroscopy - examination of the walls of the uterine cavity using a hysteroscope, followed by (if necessary) diagnostic and surgical manipulations. Hysteroscopy allows you to identify and eliminate intrauterine pathologies, remove foreign bodies, take tissue biopsies, and remove endometrial polyps.

Indications for a diagnostic procedure are:

• Anomalies in the development of the uterus.
• Bleeding in postmenopause.
• Infertility.

Indications for a surgical procedure are:

• Submucosal uterine fibroids.
• Intrauterine septum.
• Intrauterine synechia.
• Endometrial polyp.
• hyperplasia of the endometrium.

Contraindications are:

• Recently transferred or existing by the time of the study, the inflammatory process of the genital organs.
• Progressive pregnancy.
• Profuse uterine bleeding.
• Stenosis of the cervix.
• Advanced cervical cancer.
• General infectious diseases in the acute stage (influenza, pneumonia, pyelonephritis, thrombophlebitis).
• Severe condition of the patient with diseases of the cardiovascular system, liver, kidneys.

Indications for a diagnostic procedure are:

• Submucosal uterine fibroids.
• Intrauterine septum.
• Intrauterine synechia.
• Endometrial polyp.
• hyperplasia of the endometrium.
• Removal of remnants of the intrauterine contraceptive.

Indications for a surgical procedure:

• Suspicion of internal endometriosis of the uterine body, submucosal fibroid node, synechia (unions) in the uterine cavity, remnants of the fetal egg, cervical and endometrial cancer, endometrial pathology, perforation of the uterine walls during abortion or diagnostic curettage.
• Suspicion of malformations of the uterus.
• Menstrual disorders in women of childbearing age.
• Anomalies in the development of the uterus.
• Bleeding in postmenopause.
• Infertility.
• Control examination of the uterine cavity after surgery on the uterus, in case of miscarriage, after hormonal treatment.

Operative gynecology is one of the leading areas of surgical care provided in the clinics of the Mother and Child group of companies. The main attention is paid to minimally invasive and organ-saving operations, using modern methods of diagnosis and treatment. All operations are carried out in accordance with generally recognized international standards of treatment.

Our specialists - gynecologists, surgeons and anesthesiologists - doctors of the highest qualification category with many years of experience in the field of operative gynecology. All of them have academic degrees: professors, doctors and candidates of medical sciences.

The equipment of the departments of operative gynecology allows for all known and most common types of diagnostic and therapeutic surgical interventions. Hospitalization in a gynecological hospital is carried out in a planned manner, and according to emergency indications. An individual approach to each patient and the possibility of creating comfortable conditions for staying in a hospital allow us to achieve the maximum effect of the treatment.

Surgical treatment of gynecological diseases also includes an earlier start of rehabilitation measures, which allows you to achieve faster recovery and reduce the risk of postoperative complications. We use only modern recovery programs using physiotherapy methods recognized by the world medical community. This allows us to confidently guarantee all patients a complete restoration of women's health and psycho-emotional balance.

Priority areas of surgical care in "Mother and Child"

Infertility treatment

• Diagnostic laparoscopy and fertiloscopy;
• Diagnostic hysteroscopy;
• Operative hysteroscopy (hysteroresectoscopy);
• Ovarian resection (husking, removal of ovarian cysts);
• Electrocauterization and ovarian drilling;
• Coagulation and excision of foci of endometriosis;
• Surgical treatment of retrocervical endometriosis;
• Separation of adhesions in the pelvis;
• Diagnostics of the condition and restoration of patency of the fallopian tubes.

Treatment of uterine fibroids

• Hysteroscopic treatment of uterine fibroids;
• Laparoscopic treatment of uterine fibroids;
• Laparotomy treatment of uterine fibroids;
• Treatment of uterine fibroids by vaginal access;
• Embolization of the uterine arteries.

Treatment of cysts and tumors of the ovaries

• Cysts and tumors of the ovaries;
• Paraovarian cysts.

Treatment of endometriosis

• Removal of endometrioid ovarian cysts;
• Treatment of adenomyosis;
• Treatment of retrocervical endometriosis;
• Treatment of infiltrative endometriosis of the intestine and bladder;
• Treatment of infiltrative endometriosis of postoperative scars.

Treatment of prolapse and prolapse of the genital organs

• Sling operations for urinary incontinence;
• Vaginal plastic surgery;
• Manchester operation;
• Laparoscopic promontofixation (sacrovaginopexy);
• Installation of special implant systems for pelvic floor reconstruction;
• Restoration of the hymen;
• Defloration.

Treatment of anomalies (malformations) of the development of female genital organs

• Hymen atresia (absence of a natural channel or opening);
• Vaginal agenesis (complete congenital absence of an organ);
• Doubling of the uterus and vagina;
• Bicornuate uterus;
• Partitions in the uterine cavity and in the vagina;
• Gonadal dysgenesis.

Cancer treatment

• Removal of malignant neoplasms of the body of the uterus;
• Removal of malignant tumors of the cervix;
• Removal of malignant neoplasms of the ovaries.

Emergency operative gynecology

• uterine bleeding;
• ovarian apoplexy;
• ectopic pregnancy;
• purulent-inflammatory diseases of the small pelvis;
• a miscarriage that has begun, an abortion is in progress;
• not developing pregnancy.