RADICAL HYSTERECTOMY

Radical hysterectomy involves removing the uterus (womb), cervix (neck of the womb) and tissues around the cervix, the upper third of the vagina, lymph glands in the pelvis and sometimes, the fallopian tubes and ovaries.

Nerve-sparing radical hysterectomy is a modified radical hysterectomy, developed to permit surgical removal (resection) of oncologically relevant tissues surrounding the cervical lesion while preserving pelvic autonomic nerves. The pelvic automatic nerves are the pathway for the neurogenic control of rectal and bladder function and they supply blood vessels of the female internal genitals and are involved in the neural control of sexual function. Conventional Radical Hysterectomy is known to cause urinary dysfunctions, such as bladder weakness, urinary incontinence, and abnormal sensation, in 12% to 85% of patients.

Women aged 18 years or older undergoing or fit to have a conventional radical hysterectomy for early-stage (Ia2 to IIa) cervical cancer.

The main alternative is to have radical chemo-radiation therapy. Your surgeon will discuss this option with you. In general, there are benefits and risks associated with either option.

The gold standard is with open surgery ( cut on the tummy), the current evidence is supporting better survival with an open procedure. You can discuss keyhole operation ( Laparoscopic or Robotic) with your surgeon.

As with any operation, there are risks and complications which can occur but it is important to remember these risks are uncommon. The anesthetist will discuss the risks associated with a general anesthetic and your pain control after surgery.

You will have some blood loss at the time of your operation. A blood transfusion may be rarely needed to replace blood lost during the operation. On very rare occasions there may be internal bleeding which will require a second operation. Occasionally you may develop blood clots in the veins of the legs or pelvis; these clots can sometimes travel to the lungs. To minimize the risk of this we give you injections to thin the blood and try to get you to move around as soon as you are able to follow your operation.

The physiotherapist will also visit you both before and after your operation to encourage an early return to normal activity.

Also, there is a small risk of developing an infection that may be in the chest (3 in 100) wound (5 in 100), pelvis (4 in 100), or urine (10 in 100). To reduce this risk you will be given an antibiotic just before the start of the operation.

Wound breakdown rarely occurs in 5 in 1000 women needing to return to theatre for resuturing of the wound.

There is a risk that a small hole can develop in the bladder, or in the ureter (the tube which carries urine to the bladder) this may require a further procedure to correct either at the time of the operation or at a later date. Also, there is a risk that a small hole can develop in the bowel if this occurs the injury will be repaired at the time of operation. With any type of operation, there is a very small risk of death.

During your operation, a catheter is inserted into the bladder (through your abdomen), to drain off the urine. The catheter is usually left in for at least five days. It can take several weeks before your bladder begins to work properly again, and changes in bladder sensation and function may be permanent.

The nurses can teach you to catheterize yourself to help with your bladder management.

Rarely, women experience swelling in the legs or lower abdomen (lymphoedema). Sometimes patients experience numbness around the scar area and the top and outside of the legs this is due to damage to the small nerves. This may resolve with time.

There is a small risk of fluid collection where the lymph glands were removed from the pelvis; this is called a (lymphocyte). This may resolve on its own with time, however, it can be easily managed by either draining or a surgical procedure.

You may be given an epidural injection or PCA (patient controlled analgesia) device where you control the amount of pain relief according to your needs or an epidural infusion.

Following surgery you may feel sleepy; this will allow you to rest and recover. It is important to tell us if you have pain or sickness as this can be controlled with medication.

You will usually return to the ward when your condition allows from recovery.

Your bowel and bladder may take time to work normally following your operation and you may need medication to help the bowel get back to normal. Some women experience wind pain, this normally improves with increased mobility and adequate diet. However, your doctor may need to give you medication to help with this.

A radical hysterectomy may be all you need to treat your cervical cancer however, sometimes a course of radiotherapy and chemotherapy are necessary after surgery.

Your consultant will explain to you if and when this is necessary depending on your results which can take up to 7 - 10 days and you may be called back to the clinic. The results will be discussed in the tumor board (a group of doctors) and decisions will be made for any additional treatment is necessary.

Recovery It can take up to 4-6 weeks to fully recover from your operation, sometimes longer. The ward staff will give you further information about your recovery before discharge from the ward.

We recognize that having surgery can be a very emotional time for both you and your family. If you need to talk about how you feel both the Medical team and the Nurse Specialists are available to discuss any concerns you may have. After the operation, avoid having penetrative sex for about six weeks to allow the top of the vagina to heal fully. If you have any concerns please discuss this with your Nurse Specialist.

The loss of fertility can have a big impact if you have not started or not completed your family. You may want to explore this further before or after your operation. Your consultant or our team will be happy to discuss this further with you.

The ovaries make the female hormones oestrogen and progesterone, and if they are removed depending on your age you may be prescribed hormone-replacement therapy (HRT). More information is available about HRT; please ask your doctor or specialist nurse if you require further information.

If your ovaries are not removed you will continue to produce eggs, however, you will not have a monthly period and the eggs will be absorbed harmlessly by your body.

You will be given a follow up appointment before you leave the hospital.