Name of the Procedure:

Vulvectomy Simple; Complete

Summary

A vulvectomy simple; complete is a surgical procedure where the entire vulva (the external part of the female genitalia) is removed. This procedure is typically performed to treat certain medical conditions affecting the vulva.

Purpose

The procedure is primarily used to address vulvar cancer or precancerous conditions. It aims to remove the diseased tissue completely to prevent the spread or recurrence of cancer.

Indications

• Diagnosis of vulvar cancer or high-grade vulvar intraepithelial neoplasia (VIN).
• Persistent vulvar dysplasia.
• Conditions refractory to other less invasive treatments.
• Symptoms such as persistent itching or pain in the vulva not responding to other treatments.

Preparation

• Patients are typically instructed to fast for at least 8 hours before surgery.
• Medication adjustments, especially for blood thinners, may be necessary.
• Preoperative assessments include blood tests, imaging studies, and a comprehensive physical examination.

Procedure Description

1. The patient is positioned in the lithotomy position (lying on the back with legs elevated).
2. General anesthesia is administered to ensure the patient is asleep and pain-free during the procedure.
3. The surgeon makes careful incisions to remove the entire vulva.
4. The affected tissues, including the labia minora, labia majora, clitoris, and perineum, are excised.
5. The surgical area is then sutured to promote proper healing and minimize scarring.
6. A catheter may be placed to help with urination post-surgery.

Duration

The procedure typically takes about 2 to 3 hours.

Setting

The procedure is usually performed in a hospital or a specialized surgical center.

Personnel

• A gynecologic oncologist or a specialized surgeon.
• An anesthesiologist.
• Surgical nurses and assistants.
• Post-operative care team including nurses and possibly a physiotherapist.

Risks and Complications

• Infection
• Bleeding
• Pain and discomfort
• Scarring and changes in the appearance of the genitalia
• Difficulty in urination or urinary retention
• Sexual dysfunction
• Emotional and psychological impact

Benefits

The main benefit is the complete removal of cancerous or precancerous tissues, which significantly reduces the risk of cancer recurrence. Patients may start to experience these benefits within a few weeks to months post-surgery.

Recovery

• Hospital stay for a few days post-surgery to monitor recovery.
• Pain management through prescribed medications.
• Instructions on wound care to prevent infection.
• Avoid strenuous activities or sexual intercourse for 6-8 weeks.
• Follow-up appointments to monitor healing and screen for any recurrence.

Alternatives

• Partial vulvectomy or less extensive surgical options.
• Radiotherapy or chemotherapy if appropriate.
• Topical treatments or laser therapy for precancerous conditions.
• Each alternative comes with its own set of risks and benefits, and may be less effective for certain conditions compared to a complete vulvectomy.

Patient Experience

Patients will be under general anesthesia during the procedure, feeling no pain. Post-surgery, there will be discomfort and in some cases, significant pain, managed through medications. Emotional support and counseling may be beneficial in coping with the changes in appearance and function of the genitalia. Regular follow-up and supportive care are critical aspects of the recovery process.