Cervical Cancer Surgery
Fertylity-preserving Surgery in Cervical Cancer
To best treat cervical cancer patients who wish to have children, we offer radical vaginal trachelectomy according to Dargent, if the tumour size is 2 cm or less. During trachelectomy, two-thirds of the cervix and the inner half of the uterus support system are resected, but the uterine body and the opening to the uterus (endocervix) are preserved. This approach maintains the potential for a future pregnancy without increasing the risk of a relapse.
Conservative Nerve Surgery in Cervical Cancer, modified according to Prof. Possover
For many years, and practically up to the middle of the 20-th century, the classical approach in treating cervical cancer was the vaginal route. Indeed, prior to the discovery of antibiotics, the associated infection risk was much reduced in comparison with the abdominal approach. During this early period, the typical intervention was in fact much more radical than today, even though the removal of lymphatic ganglions was not possible. Because ganglions can now be removed by laparoscopy, radical hysterectomy using the vaginal route has been reintroduced. By increasing the radical approach in such surgery, the incidence of the disease decreased dramatically. Radical vaginal hysterectomy with laparoscopic removal of lymphatic ganglions remains the «new method».
To further improve the radical nature of the surgical treatment of large tumours, Prof. Possover developed a new method, called laparoscopy-assisted radical vaginal hysterectomy (LARVH). This method allows us to increase the amount of tissue removed from the cervix. However, this more radical approach also leads to an increase in the number of post-operative vesical dysfunctions. To address this problem, a modified LARVH method was developed that spares all the nerves. Because laparoscopy offers the possibility to magnify the view of structures 10- to 15-fold, the relevant nerves can be isolated and then protected throughout the surgery. These nerves are identified using the LANN technique, which can also protect vesical and intestinal nerves without compromising the radical nature of this type of surgery.