Definition and Overview

A laparoscopic radical hysterectomy is a common procedure performed for the treatment of early-stage cervical cancer. It is considered as a safer option compared to traditional surgery, especially when the cancer is caught early and has not spread to other parts of the body.

A radical hysterectomy is a surgical procedure that removes the uterus as well as the ligaments that keep it in its place, together with the cervix and a couple of inches of the vagina surrounding the cervix. Some parts of the ovaries, fallopian tubes, and lymph nodes may also be removed (hysterectomy and salpingo-oophorectomy). The exact nature of the procedure (or which organs need to be removed) is often determined during the surgery itself.

A radical hysterectomy should not be confused with a partial hysterectomy, in which only the uterus is removed. A partial hysterectomy is not performed to treat or lower the risk of cervical cancer, as it does not remove the cervix. Instead, it is performed mainly to remove fibroids.

Who Should Undergo And Expected Results

A laparoscopic radical hysterectomy is highly recommended for patients who suffer from early-stage cervical cancer. Its main goal is to remove the affected organs before cancer spreads to other body parts. The procedure also helps prevent recurrence.

The best candidates for the procedure are those with stage IA2 or IB1 cervical cancer and those whose tumour is less than 4cm. It is also most recommended for patients whose uterine size is less than 12cm.

Meanwhile, the procedure is not recommended for patients who have:

  • Large or bulky uterus

  • Large cervical tumours

  • Severe hip or joint disease

  • Intraperitoneal metastases

A laparoscopic radical hysterectomy removes the malignant tumour as well as nearby organs that may have been affected by cancer. However, the full extent of the surgery (basically determined by which organs are removed) will depend on the stage of the disease, the size of the tumour, and the patient’s age. If the patient is below 40 years old, surgeons often aim to leave at least one ovary that can produce enough hormones so that the patient will not experience early menopause. If the patient is between 40 and 50 years old, both ovaries are often removed to significantly reduce the patient’s risk of ovarian cancer.

Aside from cervical cancer, a laparoscopic hysterectomy can also be performed on patients with pelvic inflammatory disease, uterine prolapse, endometriosis or endometrial cancer, and adenomyosis.

How is the Procedure Performed?

Patients who are scheduled to undergo a laparoscopic radical hysterectomy need to go through some preparatory steps before the procedure. These include:

  • Bowel preparation or colon cleansing

  • Administration of prophylactic antibiotics

Following the administration of general or local anaesthesia, the patient is placed in the lithotomy position. The surgeon then inserts a Foley catheter and places a uterine manipulator. Once these are in place, the patient is moved to a steep Trendelenburg position (the patient lies face upward with the pelvis higher than her head). A laparoscope (a long thin tube with a high-resolution camera on one end) is then inserted to provide the surgeon with a view of the abdominal cavity. Once the surgeon has a visual guide, other surgical instruments are inserted through small strategic incisions to cut the uterus and other organs into smaller pieces before they are removed piece by piece through the tube.

A laparoscopic radical hysterectomy is just one of many ways to perform a hysterectomy, which can also be performed via traditional open surgery or through the vagina. Instead of a large abdominal incision, the affected organs are removed using several small incisions that are just big enough to fit a hollow tube through which surgical instruments are passed through. This type of procedure shortens the overall hysterectomy recovery time as well as the operating time. It can also reduce blood loss, transfusion rates, and the length of time the patient needs to stay in the hospital.

More advanced medical technology, however, gives patients the option to undergo robotic surgery, another minimally invasive technique that uses very small tools attached to a robotic arm. This technique is known to enhance the capabilities of surgeons and for improving the accuracy and precision with which surgical procedures are performed.

Possible Risks and Complications

A laparoscopic hysterectomy is considered as a relatively safe procedure with many potential benefits and a high rate of efficacy. The laparoscopic technique also significantly reduces the risks associated with traditional hysterectomy.

However, regardless of which technique is used, patients are faced with major life changes after the procedure. Since the uterus is removed, they will no longer have menstrual periods, which means losing their ability to conceive. Also, they may experience some changes in their sexual ability due to their shorter vagina and residual numbness in the genital area. Patients who experience these hysterectomy side effects may have feelings of inadequacy and low self-esteem. Thus, some also require the help of a therapist to cope with such thoughts and feelings. If the patient is very young, she may also benefit greatly from estrogen replacement therapy.

Additionally, patients may also have some difficulty passing urine while the nerves around the uterus are still healing. This is, however, a temporary side effect. If the patient is still unable to empty her bladder completely after a few weeks, she should see her doctor to check for long-term damage.

Following surgery, patients are also at an increased risk of infection, including urinary tract infections, because they cannot fully empty their bladders. Thus, doctors may teach them to perform self-catheterisation, in which they slip a small and soft catheter through the urethra and into the bladder so they can manually drain out any urine left.

References:

  • R King Erin, T Ramirez Pedro. “Laparoscopic radical hysterectomy for early-stage cervical cancer.” US Oncological Review, 2009;5(1):90-2. http://www.touchoncology.com/articles/laparoscopic-radical-hysterectomy-early-stage-cervical-cancer

  • Gottschalk E, Lanowska M, Chiantera V., et al. “Vaginal-assisted laparoscopic radical hysterectomy: rationale, technique, results.” Journal of the Society of Laparoendoscopic Surgeons. 2011 Oct_Dec; 15(4): 451-459. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340952/

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