Name of the Procedure:

Vulvectomy, Radical, Complete

• Common names: Radical Vulvectomy, Complete Vulvectomy
• Medical term: Radical Complete Vulvectomy

Summary

A Radical Complete Vulvectomy is a surgical procedure that involves the removal of the entire vulva, which includes the inner and outer labia, clitoris, and surrounding tissues. This extensive surgery is typically performed to treat advanced or aggressive forms of vulvar cancer.

Purpose

Medical Condition or Problem:

• Treats advanced vulvar cancer.
• Addresses severe dysplasia or extensive pre-cancerous conditions that cannot be managed with less extensive surgery.

Goals or Expected Outcomes:

• Removal of all cancerous tissues to prevent the spread of cancer.
• Achieve cancer remission.
• Improve survival rates and overall prognosis of the patient.

Indications

Specific Symptoms or Conditions:

• Diagnosed vulvar cancer, especially at an advanced stage.
• Recurrent vulvar cancer after other treatments.
• Extensive high-grade vulvar intraepithelial neoplasia (VIN).

Patient Criteria:

• Patients must be deemed medically fit for major surgery.
• Condition must be unmanageable by less invasive treatments (e.g., partial vulvectomy, radiation).

Preparation

Pre-procedure Instructions:

• Fasting for at least 8 hours prior to surgery.
• Adjust or stop certain medications as advised by the surgeon.
• Thorough pre-surgical evaluation, including blood tests, imaging studies (like MRI or CT scans), and possibly a biopsy.

Diagnostic Tests:

• Complete blood count (CBC)
• Imaging studies (MRI, CT scan) to assess the extent of the disease.
• Pre-operative biopsy of the vulvar tissues.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A surgical incision is made around the vulva.
3. Removal of Tissue: The entire vulva, including the inner and outer labia, clitoris, and associated tissues, are carefully removed.
4. Lymph Node Dissection: Nearby lymph nodes may be removed to check for the spread of cancer.
5. Reconstruction (if needed): Some patients may require reconstructive surgery to improve the appearance and function of the area.
6. Closure: The surgical site is closed with sutures, and a drainage tube may be placed to prevent fluid build-up.

Equipment Used:

• Surgical scalpel, scissors, and other instruments.
• Electrocautery device to control bleeding.
• Anesthesia equipment.

Duration

• The procedure typically takes between 2 to 5 hours, depending on the complexity and extent of tissue removal and any reconstructive work needed.

Setting

• Performed in a hospital operating room.

Personnel

• Surgical team led by a gynecologic oncologist.
• Anesthesiologist.
• Surgical nurses and possibly a plastic or reconstructive surgeon.

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Wound healing issues

Rare Risks:

• Deep vein thrombosis (DVT)
• Lymphedema (swelling caused by lymph fluid)
• Complications related to anesthesia

Possible Complications:

• Urinary problems
• Sexual dysfunction
• Chronic pain in the pelvic region

Benefits

Expected Benefits:

• Effective removal of cancerous tissues.
• Potential for cancer remission and improved prognosis.
• Reduction in symptoms such as pain and discharge.

Realization Timeline:

• Initial benefits are realized immediately post-surgery, with long-term benefits emerging as the patient heals and follow-up treatments (if needed) are completed.

Recovery

Post-procedure Care:

• Pain management with prescribed medications.
• Instructions on wound care and hygiene.
• Avoidance of heavy lifting and strenuous activity for several weeks.

Recovery Time:

• Full recovery typically takes 6 to 8 weeks.
• Follow-up appointments are necessary to monitor healing and detect any signs of recurrence.

Alternatives

Other Treatment Options:

• Partial vulvectomy (removal of a portion of the vulva)
• Radiation therapy
• Chemotherapy

Pros and Cons of Alternatives:

• Less invasive options like partial vulvectomy or radiation might not be as effective for advanced cancer but have fewer side effects.
• Chemotherapy can treat cancer spread but often has significant systemic side effects.

Patient Experience

During the Procedure:

• The patient will be under general anesthesia and won’t experience any pain or awareness during the surgery.

After the Procedure:

• Initial post-operative pain and discomfort managed by medication.
• Emotional and psychological support may be necessary due to the extensive nature of the surgery and its impact on body image and function.
• Gradual improvement in physical comfort and ability with adherence to recovery guidelines.