Removal of the cervix (trachelectomy)

Trachelectomy is an innovative operation performed for early-stage cervical cancer, which results in the removal of the cervix, upper part of the vagina with the obligatory preservation of the uterus, fallopian tubes and ovaries.

About the female reproductive system

The female reproductive system is located in the lower abdominal cavity (abdomen). It includes the ovaries, fallopian tubes, uterus, cervix and vagina. The uterus is located in the lower abdominal cavity between the bladder and the rectum. The lower narrow end of the uterus is called the cervix. The ovaries and fallopian tubes are connected to the uterus.

Cervical cancer is not a death sentence
Along with breast cancer, one of the most common types is cervical cancer. Pathology can be detected at different ages. However, modern treatment methods make it possible to achieve a complete recovery.

What is the type of trachelectomy

In patients with cervical cancer of reproductive age, cervical amputation (simple vaginal trachelectomy) and radical trachelectomy are used.

How the operation is performed

Radical trachelectomy is performed in the clinic under general anesthesia (you will be unconscious) or under spinal anesthesia (you will be conscious, but will not feel pain). This operation consists of 2 stages.

The first stage is the removal of lymph nodes in the pelvis and checking them for the presence of cancer cells.
While you remain in the operating room under general anesthesia, the pelvic lymph nodes are examined under a microscope to check for cancer cells. If cancer is found in the lymph nodes, the surgery is stopped. If cancer is not found, the surgeon will perform the second step - a radical trachelectomy.

The second stage is the removal of the cervix, upper vagina and surrounding tissues (parametrial tissue).
At the same time, the uterus and appendages are preserved. A uterine-vaginal connection (anastomosis) is made to restore physiological patency from the vagina to the uterus. Also, at the end of this operation, an intrauterine device is inserted to prevent infection (atresia) of the cervical canal and, in some cases, a circular suture is applied to the rest of the cervix in order to carry a subsequent pregnancy, which can be recommended no earlier than 3 months after uncomplicated surgical treatment.

The cervical tissue removed during surgery is examined under a microscope to see if there are any cancer cells. If there are cancer cells at or near the edge of the removed tissue, the surgeon may try to remove more tissue. In some cases, the surgeon may need to remove the uterus (hysterectomy) to make sure all of the tumor is removed with an adequate normal edge of tissue.

There are different methods of radical trachelectomy:
Vaginal radical trachelectomy - removal of the cervix and surrounding tissue, directly through the vagina.
Abdominal radical trachelectomy - removal of the cervix and surrounding tissues through an incision in the abdomen (access is through the abdominal cavity).
During laparoscopic radical trachelectomy, a thin tubular instrument with a light and a lens (the so-called laparoscope) is used. The surgeon makes small surgical incisions in the abdominal cavity. The laparoscope and other instruments are inserted through small incisions in the abdomen to remove the cervix and surrounding tissue.

When you can have a trachelectomy

Indications:

• the woman's age is 18-40 years;
• the patient wants to preserve her fertility;
• tumor size up to 2.5 cm in the largest dimension;
• no involvement of the upper third of the cervical canal in the pathological process;
• No signs of metastases in the regional lymph nodes;
• the first stages of the disease (cervical cancer IA1 with the involvement of cervical vessels in the process, stage IA2-IV).

What are the contraindications

• signs of infertility;
• some histological forms of cancer;
• involvement of the upper segment of the cervical canal in the pathological process;
• concomitant burdened somatic diseases.

For the correct staging of the disease, information obtained by means of pelvic ultrasound, abdominal CT, MRI of the pelvic organs, PET-CT is used, which allows to correctly assess the degree of prevalence of the tumor process and choose the most effective treatment method. When choosing a particular treatment method or their combination, experienced specialists of our clinic are guided by many factors, approaching each patient and her problem individually. The question of the possibility of performing a trachelectomy is decided individually in each case.