Name of the Procedure:

Excision of Cervical Stump, Vaginal Approach
Also known as: Cervical Stump Removal, Vaginal Cervical Stump Excision

Summary

Excision of the cervical stump through a vaginal approach is a surgical procedure where the remaining portion of the cervix is removed through the vagina. This procedure may be necessary if there are issues with the cervical stump after a subtotal hysterectomy, where the uterus is removed but the cervix remains.

Purpose

The procedure addresses complications or persistent issues related to the cervical stump, such as chronic infection, bleeding, abnormal cells, or cancerous lesions. The goal is to eliminate these problems, alleviate symptoms, and prevent further complications.

Indications

• Persistent bleeding or infection of the cervical stump
• Detection of abnormal or pre-cancerous cells
• Cancerous lesions on the cervical stump
• Chronic pain or discomfort related to the cervical stump Patients may be suitable for this procedure if non-surgical treatments have failed and they are in generally good health to undergo surgery.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to medications (e.g., anticoagulants) may be necessary.
• Preoperative assessments might include pelvic exams, blood tests, and imaging studies.
• Patients should arrange for transportation and post-operative care at home.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Positioning: The patient is positioned in lithotomy position (lying on back with legs in stirrups).
3. Incision: A surgical speculum is inserted into the vagina to view the cervical stump.
4. Excision: The surgeon uses specialized instruments to carefully excise the cervical stump.
5. Closure: The vaginal incision is sutured closed to promote healing.
6. Final Checks: Ensuring bleeding is controlled and no complications.

Tools and technology used may include surgical speculums, scalpels, electrosurgical devices, and suturing equipment.

Duration

The procedure typically takes around 1 to 2 hours, depending on complexity.

Setting

Performed in a hospital's surgical suite or an outpatient surgical center.

Personnel

• Gynecologist or specialized surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and possibly a surgical technician

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs (e.g., bladder, bowel)
• Anesthesia-related risks
• Scar tissue formation (adhesions)
• Post-operative pain

Benefits

• Relief from symptoms such as pain, bleeding, or discomfort
• Removal of abnormal or cancerous tissue to prevent further health issues
• Improved quality of life

Benefits are often realized immediately after recovery, although some symptoms may take time to fully resolve.

Recovery

• Patients should expect some discomfort and may be prescribed pain relievers.
• Activity restrictions for several weeks, including no heavy lifting or sexual activity.
• Follow-up appointments to monitor healing and address any concerns.
• Full recovery typically takes 4 to 6 weeks.

Alternatives

• Watchful waiting with close monitoring of symptoms
• Non-surgical treatments such as medications or less invasive procedures
• Benefits of excision include definitive resolution of issues; cons may include surgical risks and recovery time.
• Other options may offer less immediate resolution but fewer surgical risks.

Patient Experience

• Patients may experience varying levels of discomfort during recovery.
• Pain management includes prescribed medications and measures like rest and ice packs.
• Emotional support and clear communication with healthcare providers can facilitate a smoother recovery process.

Patients are encouraged to discuss any concerns or questions with their healthcare provider to ensure they are fully informed about what to expect.