Cervical cancer surgery starts under the auspices of two basic principles: preserving the fertility of women of reproductive age who wish to bear children in the future, and individualized treatment, depending on the stage of the disease, the extent of the cancer and ways of preventing recurrence.
Cervical cancer surgery is divided into two types: early cervical cancer surgery, we are talking about stage 1A and 1B1, i.e. tumors under 2 cm, and advanced cervical cancer surgery, tumors over 2 cm, with the potential to spread and evolve.
What is cervical cancer conservative surgery?
Conservative cervical cancer surgery provides a safe treatment for the cancer, but allows the woman’s uterus to be preserved. This is a major benefit for young patients who want to have children in the future and who can therefore carry a pregnancy to term, even if they have been treated for cancer. In the early stages of cancer, if the patient wishes to have children, conservative treatments can be done so that she can preserve her menstrual function and reproductive capacity.
Usually the cervix is excised, along with the surrounding tissues, where the cancer frequently spreads, along with the lymph nodes. This allows us to preserve the uterus, which is essential for the implantation of a pregnancy.
Conservative surgery called trachelectomy is performed in carefully selected cases in the early stages, where the cancer is located strictly in the cervix, in 2 steps:
- Identification of the sentinel node, by injecting a colored substance, to identify the lymph nodes on the right and left, where the tumor most frequently drains.
- The ganglion is excised, it is sent to pathological anatomy, where the histopathological examination takes place, which tells you if the tumor has invaded the tissue or not. It is performed intraoperatively, so that a decision can be made during the intervention.
- If it is negative, you can do the conservative surgery, pelvic lymphadenectomy, followed by trachelectomy – excision of the cervix with the surrounding tissue.
- If not, you need to do radical hysterectomy with pelvic lymphadenectomy.
State of the art surgery in cervical cancer treatment
Conservative surgery using robotic surgery allows an accurate identification of the sentinel node, with better visibility and more precise identification of the sentinel node and the entire lymph pathway. By means of robotics, a substance can be injected that identifies the sentinel node much better, the robot having an infrared video camera and injecting indocyanine green, it can identify the whole lymph pathway as well as the sentinel node.
An important benefit is to perform a thorough lymph node excision with excision of the pelvic lymph nodes. The parametrial tissues around the uterus can be excised in order to preserve the pelvic nerves, which ensure normal function of the large bowel, bladder and maintenance of sexual function.
Prof. Dr. Elvira Brătilă has been performing conservative cervical cancer surgery since 2006, that year she performed vaginal surgery with laparoscopic lymphadenectomy.
Since 2014, the doctor has performed this surgery totally laparoscopically, and in 2017, with the introduction of robotic surgery, she started this new technique, with undeniable benefits for surgeon and patients, being the first surgeon in Romania, among the few in Europe, who performed pelvic lymphadenectomy, followed by trachelectomy – excision of the cervix with surrounding tissue – in a totally minimally invasive way.
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