58210 Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s)

Name of the Procedure:

Radical Abdominal Hysterectomy with Bilateral Total Pelvic Lymphadenectomy and Para-Aortic Lymph Node Sampling (Biopsy), With or Without Removal of Tube(s) and Ovary(s)

Summary

A radical abdominal hysterectomy involves the surgical removal of the uterus, cervix, and part of the vagina, along with surrounding tissues. This procedure is often combined with the removal of lymph nodes from the pelvic and para-aortic regions and can include the removal of the fallopian tubes and ovaries depending on the patient's condition.

Purpose

This procedure addresses certain types of gynecologic cancers, such as cervical or endometrial cancer. The goal is to eliminate cancerous tissues to prevent the spread of disease, thereby improving the patient’s prognosis and survival.

Indications

• Diagnosis of cervical or endometrial cancer.
• High-grade pre-cancerous changes in the cervix.
• Large, symptomatic benign tumors where other treatments have failed.
• Recurrent pelvic cancer after prior treatments.

Preparation

Patients are generally instructed to fast for 8-12 hours before surgery. Pre-operative diagnostic tests, such as blood tests, imaging studies (CT scan, MRI), and ECG, may be required. It's crucial to discuss any current medications with the doctor, as some might need to be adjusted.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A vertical or horizontal incision is made in the abdomen.
3. Removal of Uterus: The uterus, cervix, and part of the vagina are carefully removed.
4. Lymphadenectomy: Lymph nodes in the pelvis and around the aorta are excised for sampling.
5. Optional Removal: The fallopian tubes and ovaries may be removed based on the cancer type and patient age.
6. Closure: The incision is closed with sutures or staples.

The procedure employs surgical tools such as scalpels, clamps, and often utilizes advanced imaging technologies for better accuracy.

Duration

The surgery typically takes 3-4 hours.

Setting

This procedure is performed in a hospital’s operating room.

Personnel

• Gynecologic oncologist or surgeon
• Anesthesiologist
• Surgical nurses
• Scrub techs

Risks and Complications

• Bleeding
• Infection
• Injury to surrounding organs (bladder, bowel)
• Blood clots
• Lymphocele formation
• Delayed wound healing
• Early menopause if ovaries are removed

Benefits

• Removal of cancerous tissues.
• Reduced risk of cancer recurrence.
• Improved survival rates. Benefits may be realized soon after recovery, though full benefits depend on post-operative pathology results and subsequent treatments.

Recovery

Patients are typically hospitalized for 3-5 days. Post-procedure instructions include pain management, avoiding strenuous activity, and monitoring for signs of infection. Full recovery may take 6-8 weeks, during which regular follow-up appointments are essential.

Alternatives

• Chemotherapy and radiation therapy for those unfit for surgery or where surgical intervention is not appropriate.
• Less radical surgeries (simple hysterectomy)
• Palliative care in cases where the goal is comfort rather than cure.

Each alternative has its own pros and cons, depending on the stage and type of cancer and the patient's overall health.

Patient Experience

During the procedure, the patient will be under general anesthesia and won’t feel anything. Post-surgery, patients can expect pain at the incision site, manageable with prescribed pain relievers. Fatigue and restricted activity levels are common for several weeks.