Name of the Procedure:

Trachelectomy (cervicectomy), amputation of cervix

Summary

A trachelectomy, also known as a cervicectomy, is a surgical procedure that involves the removal of the cervix. This can be performed as a separate procedure, distinct from other types of gynecological surgery.

Purpose

Trachelectomy is primarily performed to treat early-stage cervical cancer or severe precancerous conditions. The goal is to remove diseased tissue while preserving as much of the uterus as possible, which can be particularly important for women who wish to retain their fertility.

Indications

• Cervical cancer in its early stages
• Severe cervical dysplasia (precancerous changes)
• Recurrent or persistent high-grade lesions after other treatments Patient criteria include women diagnosed with early-stage cervical cancer who wish to maintain their fertility, and those with severe precancerous changes that have not responded to less invasive treatments.

Preparation

• Fasting for 8-12 hours prior to the procedure
• Adjustments or discontinuation of certain medications (e.g., blood thinners)
• Pre-procedure diagnostic tests such as Pap smears, colposcopy, MRI, or CT scans

Procedure Description

1. Anesthesia is administered, typically general anesthesia.
2. A speculum is inserted into the vagina to allow access to the cervix.
3. The surgeon uses a scalpel or specialized surgical instruments to remove the cervix.
4. The top of the vagina is then stitched closed, and a small band of tissue from the cervix may be left in place for structural support.
5. The area is inspected to ensure no abnormal tissue remains.

Tools and equipment used include scalpels, surgical clamps, and suturing materials.

Duration

The procedure typically takes 1-2 hours.

Setting

A trachelectomy is usually performed in a hospital or surgical center.

Personnel

• Surgeon (Gynecologic Oncologist)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs
• Incontinence
• Scar tissue formation
• Infertility or complications in future pregnancies
• Anesthetic complications

Benefits

• Removal of cancerous or precancerous tissue
• Potential preservation of fertility
• Minimally invasive compared to full hysterectomy
• Relief from symptoms associated with cervical abnormalities

Benefits are typically realized immediately with complete removal of the diseased tissue. Fertility preservation offers long-term benefits for family planning.

Recovery

• Hospital stay of 1-2 days post-surgery
• Pain management with prescribed medications
• Avoidance of heavy lifting, sexual activity, and vigorous exercise for 4-6 weeks
• Follow-up appointments to monitor recovery and ensure no recurrence of disease

Alternatives

• Total Hysterectomy: Removal of the uterus, which eliminates the chance of future pregnancies.
• Radiation Therapy: Non-surgical treatment that may affect fertility.
• Conization: Removal of a cone-shaped section of the cervix (less extensive than trachelectomy but may not be as effective in some cases).

Each alternative has its pros and cons, depending on the extent of the disease, the patient's health, and fertility considerations.

Patient Experience

Patients might experience pain and discomfort in the days following the procedure, which can be managed with pain medication. There may be vaginal bleeding or discharge for several weeks. Emotional support and counseling may be beneficial, particularly for those concerned about fertility and future pregnancies.