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Gynecological Oncology


GYNECOLOGICAL ONCOLOGY
LAPAROSCOPIC NERVE-SPARING ONCOLOGICAL SURGERY

Laparoscopic Surgery for Cervical Cancer

Every scientific article written on laparoscopic lymphadenectomy (removal of the lymph nodes) with radical vaginal hysterectomy (Schauta procedure) has demonstrated that this procedure has significantly reduced blood loss and blood transfusion rates to less than 15%. The laparoscopic approach leads to a faster recovery and a shorter hospital stay compared with other types of hysterectomy.

The classical Schauta operation often led to bladder and bowel complications and other problems related to nerve damages. The magnification power of laparoscopic cameras makes it possible to identify and functionally test the pelvic nerves to ensure their proper function after surgery. This resulted in the development of parasympathetic nerve-sparing laparoscopic radical vaginal hysterectomy type 3 – or simply, the “Possover procedure.” Professor Possover is one of the qualified few to perform this procedure. He has performed more than 3,000 laparoscopic lymphadenectomy procedures and more than 900 nerve-sparing laparoscopic surgeries for the treatment of cervical cancer.

In women with early-stage cervical cancer, the “radical vaginal trachelectomy” is a fertility-preserving procedure in which the cervix and surrounding tissues are removed via the vagina, while the lymph nodes are removed by laparoscopy. Because the uterus is spared, future pregnancy is possible. Women who become pregnant after a trachelectomy must give birth by cesarean section.

Laparoscopic Surgery for Uterine Cancer

Laparoscopic surgery for uterine cancer consists of a hysterectomy (removal of the uterus) with the removal of the ovaries as well as the pelvic and abdominal lymph nodes, using a minimally invasive surgical technique. If cervical involvement is detected, the Schauta operation is performed with or without the additional Possover procedure, as needed.

In all of the procedures described above, the duration of surgery is approximately 2 to 3 hours and the stay in hospital ranges from 2 to 5 days, depending on the severity of pain and the patient’s general condition.

Management for Advanced Gynecological Cancer

Patients with advanced cervical cancer (tumor size greater than 4 cm) and lymph node involvement are treated with a combination of radiotherapy and chemotherapy. The laparoscopic lymphadenectomy is recommended for optimal treatment planning. Factors such as the potential involvement of pelvic lymph nodes and degree of the cancer spread (metastasis) to the surrounding pelvic tissues and / or blood vessels have a decisive impact on the survival of cervical cancer patients. These are factors that can be very reliably identified by laparoscopy. Therefore, laparoscopy allows for optimal, stage-specific treatment of cervical cancer.

After receiving the final histology results, the surgeon can decide upon the further course of treatment together with the patient. Because the laparoscopic procedure does not entail major open surgery, radiotherapy and / or chemotherapy can be started much sooner after open surgery. Moreover, laparoscopy reduces the risk of postoperative adhesions (fibrous bands that form between tissues and organs) and wound healing disorders. Last but not least, the patient can be actively involved in medical decision-making. Laparoscopic staging surgery generally requires only a one-night stay in the hospital.