A radical trachelectomy is an operation to remove most of the cervix and the upper part of the vagina. The womb is left in place and so it may be possible to have a baby afterwards.
You might have this type of operation for a small stage 1 cancer.
You have the operation while you are asleep (under general anaesthetic). During the operation, your doctor (gynaecological oncologist), also removes the tissue around the cervix and the nearby lymph nodes.
The lymph nodes are part of the lymphatic system. If cancer cells break away from a tumour, the first place they can travel to is the nearest lymph nodes. So your doctor removes them and checks for cancer cells.
Before the operation
Your doctor will check that you are fit and well enough for a general anaesthetic. They will talk to you about the operation and answer any questions you might have.
Having a general anaesthetic means that you won’t be able to eat or drink for a number of hours beforehand. You usually stop eating at least 6 hours before the procedure. You can usually drink water up to 2 hours beforehand. Your nurse will give you instructions about this.
Your doctor usually removes the tumour through your vagina or they may make a cut (an incision) in the tummy (abdomen) to do the operation instead.
They remove most of the cervix, but leave behind the internal opening. They stitch this tight, leaving a small opening to allow blood to escape during your period.
The stitch is strong enough to support a growing baby in the future. The baby would be born by caesarean section.
Removing lymph nodes
During the operation, your doctor removes the lymph nodes around your cervix and womb to check if the cancer has spread. They usually do this by keyhole surgery.
Keyhole surgery is also called minimal access or laparoscopic surgery. Instead of one large wound site on your abdomen you have several smaller wounds, each usually less than a centimetre long.
Your doctor usually makes up to 5 small cuts through your skin in your lower abdomen. They put small surgical instruments and a laparoscope through these to carry out the operation. A laparoscope is like a narrow telescope that lights and magnifies the inside of your body. Your doctor can see the images on a TV screen.
In a few specialist hospitals, the doctor may use a special machine (robot) to help with laparoscopic surgery. This is called assisted robotic surgery or da Vinci surgery.
The doctor sits at a control unit a few feet away from the patient. The doctor controls the movement of a set of robotic surgical equipment, guided by a video camera. This gives them a 3D view, which they can magnify a number of times. This helps the doctor carry out difficult operations using very precise movements.
The photo below is an example of robotic surgery. You can see the doctor sitting at the control unit on the right of the picture.
Your doctor sends the tissue that they remove, including the lymph nodes, to the laboratory. This is to check that they have removed all of the cancer in the cervix, and to see if there are any cancer cells in the lymph nodes.
Your specialist will offer you more treatment if there is a risk that cancer cells have been left behind, or if there is any sign that the cancer has spread. This might include surgery to remove your womb (hysterectomy) or chemotherapy with radiotherapy (chemoradiotherapy).
Having further treatment means that you will no longer be able to become pregnant in the future. This can be very upsetting if you were hoping to have a family. Your doctors and nurses will do all they can to support you.
You usually stay in hospital for 1 or 2 nights. It can take up to 4 to 6 weeks to fully recover from the operation.
There are risks with any type of surgery, but most women don’t have problems after a radical trachelectomy. Your doctor makes sure the benefits of having the surgery outweigh any possible risks.
Follow up appointments
You have follow up appointments to check your recovery and sort out any problems. Your gynaecological oncologist may give you the results of the surgery during your first follow up appointment. Or some hospitals may phone you with the results.
You can contact your GP or your specialist nurse if you have any problems between appointments.