This information has been provided to help answer some of the questions you may have about total laparoscopic radical trachelectomy.
Total Laparoscopic Radical Trachelectomy (TLRT)
What is a radical trachelectomy?
Radical trachelectomy is the surgical removal of the neck of the womb (cervix), some of its surrounding tissue, top of the vagina and the lymph glands from the pelvis.
It is a surgical technique that is carried out on women who wish to preserve their fertility following the diagnosis of early stage cervical cancer.
The radical trachelectomy is performed while you are asleep under general anaesthetic using one of the following three methods:
· Radical abdominal trachelectomy (RAT) – This procedure is offered to women who have early stage cancers of the cervix. In this operation a cut is made on your tummy in order to surgically remove the cervix, a small part of the vagina, the tissue surrounding the cervix and the pelvic lymph nodes.
· Radical vaginal trachelectomy (RVT) - This operation is done both laparoscopically (where three or four small incisions are made in the tummy) and through the vagina. It involves removing the whole of the cervix and a small part of the vagina, the pelvic lymph nodes and the tissue around the cervix.
· Total laparoscopic radical trachelectomy (TLRT) - The entire operation is usually performed laparoscopically via four tiny cuts on your tummy. This allows removal of the cervix, surrounding tissue, top of the vagina and the lymph glands.
What is the aim of treatment?
The aim of radical trachelectomy is to ensure complete removal of the cancer and to be sure that only normal tissue remains. Your doctor will discuss the result of the operation with you and decide if you need either further surgery to remove the womb or radiotherapy treatment to destroy any remaining cancer cells.
Note that if during the operation it is suspected that the cancer has spread the operation may be converted to a radical hysterectomy (where the cervix, uterus, top of the vagina and the tissues around the cervix and pelvic lymph glands (nodes) are removed) or abandoned in favour of chemotherapy/radiotherapy.
What happens before your operation?
Prior to the operation you will have a consultation and an MRI scan to locate the position and the size of the cancer, and to ensure the cancer has not spread. Your consultant will review this in addition to other results from scans, examinations and biopsies.
Are there any risks associated with radical trachelectomy?
All operations carry a certain degree of risk, the risks associated with a radical trachelectomy include:
· Infections (usually minor wound or urine infection)
· Bladder complications, including difficulty emptying the bladder and injury to the ureter
· Injury to the bowels
· The bladder and bowels may take a few days to start working properly again
· Injury to nerves
· Deep vein thrombosis (DVT)
· Pulmonary embolism
· Lymphoedema (swelling of the legs)
· Haemorrhage (internal bleeding)
· Haematoma (bruising under the skin)
· Needing to convert the operation to a laparotomy, which is an ‘open’ operation where a larger cut is made across the lower abdomen (tummy)
· Fertility problems and risk of miscarriage - Please note we are unable to guarantee that your fertility will be preserved after this operation. If you do get pregnant after the operation, there is also a possibility of miscarriage.
Usually during the operation, your surgeon will insert a large permanent suture (stitch) around the opening of the uterus, strong enough to reduce the risk of a miscarriage.
Are there any alternatives to this operation?
A radical trachelectomy is offered to women who wish to preserve their fertility. The alternative to this operation is a radical hysterectomy which is the standard procedure for cervical cancer. This involves total removal of the uterus (womb) which means you will not be fertile.
Chemotherapy/radiotherapy is offered for larger tumours (cancers) and where there is evidence that lymph nodes are strongly suspected of or known to contain cancerous cells.
What happens after the operation?
After the operation you will stay in hospital for at least 2 to 3 days. The bladder may take some time to begin working properly. A urethral catheter (tube) will be inside your bladder to drain urine away through your urethra (passage through which you normally pass urine) and to allow the bladder to recover.
The catheter will be removed after about 5 days. If you are discharged prior to this you will have to come back to hospital to have it removed.
You may have some vaginal bleeding or a bloodstained discharge but this does not usually last more than a few days.
You may also have wind and have trouble opening your bowels for the first few days after the operation. This is temporary and we can give you laxatives if you need them. The gas that is used to distend your tummy during the keyhole operation may also make you feel bloated as well as cause pain in your shoulders. Again, this is temporary and will eventually get better over a few days.
We will encourage you to do gentle leg and breathing exercises to help with circulation and prevent chest infections. You will also be encouraged to get out of bed and start moving around as soon as possible, as this will help with your recovery.
You will be supplied with anti-clotting injections to take home. You will be shown how to inject yourself before you are discharged. It is advised to arrange for someone to collect you by car or accompany you home in a taxi, as you will not be able to drive yourself or travel on public transport.
Is there anything I need to watch out for at home?
Please contact your GP or key worker, or go to your nearest accident & emergency (A&E) department if you have:
Excessive redness or discharge around your wound site High temperature or fever (38°c or above) Heavy vaginal bleeding Offensive smelling discharge from your vagina Pain or swelling in your calves or in the veins in your leg Difficulty in breathing Difficulty in passing urine
The above list is by no means exhaustive.
If you are worried about anything, you should either go to your surgery, contact your key worker or the gynaecology ward.
What happens when I leave the hospital?
It is normal to feel tired when you go home, and you may find that you need extra sleep and rest during the day. Avoid lifting anything heavy and any strenuous activities for four to six weeks after your operation or until advised otherwise by your Doctor. It is advised to do gentle activities and exercises such as light dusting, washing up and walking as this is an important part of your recovery.
When can I start driving again?
You are advised not to drive for about four weeks after your operation. However, this period may be longer if your operation is converted to ‘open’.
When can I return to work?
You may return to work four to six weeks after surgery, but this will depend on the type of work you do and your individual recovery.
When can I have sex?
We advise you not to have sex for at least six weeks after surgery. It can take at least six weeks for the top of the vagina to heal and even longer for energy levels and sexual desire to get back to normal.
We will advise you to use contraception for at least six months after surgery. Your body will need this time to recover from the operation before it can carry a baby. Please discuss this further with your doctor if you wish.
Will I need to visit the hospital again?
Yes, for a check-up in the outpatient clinic. We will check that your wound is healing well, give you your final results and discuss whether further treatment is recommended. We will also give you a vaginal examination to check that it is healing and may take a smear from the top of your vagina once it has fully healed.
You will need to return to clinic regularly over the next five years (every three months to start with) to check that there are no signs of the cancer returning.
This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.