Vulvectomy, radical, partial; with unilateral inguinofemoral lymphadenectomy
CPT4 code
Name of the Procedure:
Vulvectomy, Radical, Partial with Unilateral Inguinofemoral Lymphadenectomy
Summary
A radical partial vulvectomy with unilateral inguinofemoral lymphadenectomy is a surgical procedure that involves the removal of part of the vulva (external female genitalia) along with lymph nodes located in one groin area. This is usually done to treat vulvar cancer.
Purpose
The primary purpose of this procedure is to remove cancerous tissues in the vulva and to assess or remove lymph nodes that may be affected by cancer. The goal is to eradicate cancer, prevent its spread, and thereby improve survival and quality of life.
Indications
- Diagnosed vulvar cancer, specifically when it's localized but has the potential to spread to lymph nodes.
- Symptoms such as vulvar lumps, sores, itching, or bleeding.
- Patients assessed as suitable based on their overall health and cancer staging.
Preparation
- Patients are commonly instructed to fast for 8 hours before surgery.
- Medication adjustments, such as stopping blood thinners, as directed by the healthcare provider.
- Preoperative diagnostic tests may include blood work, imaging studies like ultrasound or MRI, and a thorough physical examination.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is asleep and free of pain during the procedure.
- Initial Incision: An incision is made around the area of the vulva to be removed.
- Tissue Removal: The surgeon removes the identified portion of the vulva.
- Lymphadenectomy: Through a separate incision in the groin, lymph nodes are identified and removed.
- Closure: Both incisions are closed with sutures, and a dressing is applied.
The procedure utilizes surgical scalpels, retractors, and sutures. Ensuring sterile techniques and precise dissection is crucial.
Duration
Typically, the surgery lasts between 2 to 4 hours, depending on the extent of the operation and any complicating factors.
Setting
This procedure is performed in a hospital operating room, equipped with full surgical and anesthetic capabilities.
Personnel
- Surgeons: Specializing in gynecological oncology.
- Nurses: Assisting during surgery and caring for the patient pre- and post-operation.
- Anesthesiologists: Managing anesthesia before, during, and immediately after the procedure.
Risks and Complications
- Common risks: Bleeding, infection, pain at the surgical site.
- Rare risks: Lymphedema (swelling due to lymph fluid), deep vein thrombosis (DVT), adverse reactions to anesthesia, wound healing problems.
- Management includes antibiotics for infection, pain relief medications, and close monitoring.
Benefits
The main benefit is the potential cure or control of vulvar cancer, significantly improving the patient’s prognosis. Benefits are typically realized within weeks after complete recovery.
Recovery
- Immediate post-procedure care includes pain management, wound care, and monitoring for complications.
- Recovery time typically ranges from 4 to 6 weeks, during which physical activity may be limited.
- Follow-up appointments are essential to monitor healing and to check for any signs of cancer recurrence.
Alternatives
- Radiation therapy: Often used for patients who are not surgical candidates.
- Chemotherapy: May be considered depending on the type and stage of cancer.
- Less invasive surgical options: If the cancer is detected at a very early stage.
Each alternative has differing pros and cons related to efficacy, side effects, and patient suitability.
Patient Experience
Patients will likely feel groggy and sore immediately after surgery. Pain management through prescribed medications is critical. Emotional support and comfort measures, such as rest and wound care, help during the recovery period. Some loss of sensation or altered appearance of the vulva may occur post-surgery.
Note to Patients:
Please consult your healthcare provider for detailed pre- and post-operative instructions tailored to your specific needs and condition.