Vulvectomy, radical, partial
CPT4 code
Name of the Procedure:
Vulvectomy, Radical, Partial
Summary
A radical partial vulvectomy is a surgical procedure that involves the removal of a part of the vulva, which is the external part of the female genitalia. This surgery aims to remove cancerous tissues or other serious medical conditions affecting the vulva while preserving as much normal tissue as possible.
Purpose
The primary purpose of a radical partial vulvectomy is to treat vulvar cancer or precancerous conditions. The goal is to remove the diseased tissue to prevent the spread of cancer while preserving the maximum possible amount of healthy tissue for better functional and aesthetic outcomes.
Indications
- Diagnosed vulvar cancer or high-grade vulvar intraepithelial neoplasia (VIN)
- Persistent, severe vulvar conditions that do not respond to less invasive treatments
- Recurrence of vulvar cancer after previous treatment
Preparation
- The patient may be advised to fast for several hours before the procedure.
- Preoperative assessments, including blood tests and imaging studies, are conducted.
- Patients may need to discontinue certain medications, such as blood thinners, before the procedure.
- A thorough discussion with the surgical team to understand procedure details, risks, and post-operative care.
Procedure Description
- Anesthesia: General or regional anesthesia is administered.
- Incision: The surgeon makes precise incisions around the affected area.
- Tissue Removal: Diseased tissue, including a margin of healthy tissue, is carefully removed.
- Closure: The remaining skin is closed with sutures, and drains may be placed to prevent fluid accumulation.
- Final Steps: Dressings are applied, and the patient is monitored during recovery from anesthesia.
Tools and equipment include surgical scalpels, forceps, sutures, and possibly advanced imaging for guidance.
Duration
The procedure typically takes 1-3 hours, depending on the extent of tissue removal required.
Setting
A radical partial vulvectomy is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeons specializing in gynecologic oncology
- Anesthesiologists
- Surgical nurses and assistants
Risks and Complications
- Infection
- Bleeding or hematoma formation
- Scarring and changes in vulvar appearance
- Pain and discomfort
- Possibility of incomplete removal of cancerous tissue requiring additional treatment
Benefits
- Removal of cancerous or precancerous tissue
- Reduced risk of cancer spread or recurrence
- Preservation of more healthy tissue compared to a complete vulvectomy
- Potentially better functional and cosmetic outcomes
Recovery
- Hospital stay of 1-2 days post-surgery may be required.
- Pain management with prescribed medications.
- Instructions to keep the surgical area clean and dry.
- Avoidance of strenuous activities and sexual intercourse for several weeks.
- Follow-up appointments to monitor healing and evaluate for any signs of recurrence.
Alternatives
- Less invasive options like laser therapy, especially for precancerous lesions.
- Chemoradiation in cases where surgery may not be feasible.
- Simple excision or biopsy for very localized lesions.
- Each alternative comes with different effectiveness and side effect profiles, depending on the individual case.
Patient Experience
- During the procedure: No pain due to anesthesia, though some sensation may be experienced if under regional anesthesia.
- After the procedure: Pain and discomfort around the surgical site, managed with medications.
- Swelling and bruising are common, and emotional support may be necessary due to changes in body image.
- Gradual return to normal activities as per medical advice.