Radical Hysterectomy

Hysterectomy is the surgery to remove the uterus from the female body. The type of hysterectomy in which the uterus, ovaries, cervix, both fallopian tubes and other surrounding tissues that include lymph nodes are removed is called radical hysterectomy.

The surgery called radical hysterectomy was developed in the 19th century to treat cervix problems and cancer associated with the cervix. It was developed in order to help women facing injuries in the urinary tract, hemorrhage, fistulas, and sepsis.

Steps for radical hysterectomy

Step 1 

Opening the Abdomen

The surgeon makes the incision in the abdomen longitudinally, followed by ligating and cutting broad ligaments.

Step 2 

There are three kinds of bodily spaces that need to be explored called retroperitoneal spaces, 

  • 1. Paravesical space
  • 2. Pararectal space (also called Latzko’s space)
  • 3. Pararectal space (also called Okabayashi).
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Step 3 

Pelvic lymphadenectomy involves the dissection of lymph nodes. 

Step 4 

The uterine artery is subsequently dissected 

Step 5 

The hypogastric nerve is preserved to maintain urinary function. In case the patient has cancer invasion of the rectovaginal ligament or cardinal ligament, then the surgeons are unable to preserve the hypogastric nerve. 

Step 6 

Clamping and cutting of the following ligaments are performed carefully in an orderly manner according to the requirement of the surgery ans physiological functioning of the body organs associated with these ligaments:

  • 1. Cardinal ligament 
  • 2. Rectovaginal ligament
  • 3. Vesicouterine ligament
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Step 7 

Vagina amputation involves the opening of vaginal walls by a scalpel.

Step 8 

Closing abdomen

Saline is used to washing retroperitoneal space appropriately and is cleaned to prevent infections, contamination and further bleeding.

Radical hysterectomy procedure

The procedure for Radical hysterectomy involves the following :

The patient is given general anesthesia and then examined. The abdominal incision is made in either the low transverse or vertical in the belly. The surgeon explores the pelvic and abdominal peritoneum carefully. 

The tissues and organs are checked for metastasis and injuries, and accordingly, the organs are removed along with the uterus. 

Finally, the sterilization and appropriate cleansing is done and incision or cuts made fo the surgery are closed. In traditional method, stitches or sutures are made while in advanced methods of radical hysterectomy hypafix is used to cover the tiny cuts that heal in few days. 

Side Effects of Radical Hysterectomy

Some of the side effects seen after radical hysterectomy:

  • 1. Vaginal drainage (may occur in some patients for six weeks after radical hysterectomy surgery) 
  • 2. Irritation in wounds (incisional sites)
  • 3. Swelling and bruising at the incision site
  • 4. Insomnia
  • 5. In case ovaries are also removed, menopausal symptoms (Hot flashes, Vaginal dryness) may occur.
  • 6. Emotional health problems
  • 7. Painful sex in some cases
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Radical Hysterectomy Indications

Here are some indication for radical hysterectomy:

  • 1. Cervical cancer that is invasive in nature
  • 2. Vaginal cancer invades surrounding organs and tissues.
  • 3. Endometrial cancer (causing gross invasion of other organs)
  • 4. Recurrent or persistent cervical cancer 
  •  

The Radical abdominal hysterectomy is the procedure that treats cancers at a certain stage to prevent invasion of other organs. 

Radical hysterectomy involving “bilateral salpingo-oophorectomy”

Hysterectomy means removal of the uterus, and total hysterectomy involves the removal of the uterus along with the cervix. Another type of hysterectomy is salpingo-oophorectomy, wherein the uterus plus both the ovaries (bilateral) and fallopian tubes are removed. 

Classifications of Radical Hysterectomy

The classification of radical hysterectomy is done on the basis of the extent of lateral resection. There are four types of radical hysterectomy:

  • 1. Open 
  • 2. Vaginal 
  • 3. Laparoscopic 
  • 4. Robotic
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Four classes of Radical hysterectomy are :

Classes

Radical hystrerctomy

Class I

Extrafascial hysterectomy.

Class II

Modified type of radical hysterectomy (by Wertheim’s)

Class III

Meigs’ classical radical hysterectomy

Class IV

Extended type of Radical Hysterectomy

Class V

Partial Exenteration

Another classification was given for radical hysterectomy in subsequent years, which was also updated in 2017. 

A Radical Hysterectomy to treat Cervical Cancer

Cervical cancer is the abnormal growth of cells in the cervix; the lower part of the uterus help connect the uterus to the vagina. HPV (human papillomavirus) is cervical cancer’s most common causative agent. The cancer is a serious and slow-growing health-threatening condition, and radial hysterectomy becomes the last resort for treating cervical cancer.

Detecting cervical cancer at the early stages, when it has not spread beyond the cervical region and the tumors are smaller, gives the chance of a cure to the disease.

According to research studies, there is an almost 80% cure rate for cervical cancer that can be detected early and is confined to the cervix by radical hysterectomy. 

Complications of Radical Hysterectomy

Some of the complications that arise after radical hysterectomy

  • 1. Urinary dysfunction
  • 2. Lymphedema
  • 3. Extensive scarring in the abdomen 
  • 4. Fistula formation (can be vesicovaginal or rectovaginal)
  • 5. Compromised or altered sexual function
  • 6. Infertility problems
  • 7. Lymphocyst formation
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Frequently Asked Questions

What is the basic difference among two kinds of hysterectomy procedures namely hysterectomy and radical hysterectomy?

Hysterectomy involves the removal of the uterus, while radical hysterectomy involves the removal of the uterus along with some of the parts that are present alongside the cervix, like ovaries, lymph nodes, vagina, and fallopian tubes.

Why would any woman need to have a radical hysterectomy?

Radical hysterectomy is primarily needed in case the patient has major complications with the uterus, cervix, fallopian tubes, ovaries or vagina. Radical hysterectomy becomes the last resort after the treatments given for cervical cancer, like chemotherapy or radiation therapy. 

Radical hysterectomy is advantageous over radiotherapy, given as a treatment option for cancers in the vagina, uterus, or cervix. It can preserve the functioning of ovaries in younger female patients. There is allowed direct evaluation of activity and condition of lymph nodes. Also, it does not affect the essential vaginal length. 

What are some of the outcomes in the body after a woman gets radical hysterectomy done?

Some of the problems that may arise after radical hysterectomy:

  • 1. Mild vaginal bleeding
  • 2. Dark-colored vaginal discharge
  • 3. Bruising and redness in the abdomen
  • 4. Itching around wounds
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Apart from the mild problems that some patients may face immediately after radical hysterectomy; there are a lot of health complications that are sorted after radical hysterectomy like 

Gynecological cancers are eventually treated (ovarian cancer, uterine cancer or ce5vical cancer)

Uterine problems of endometriosis, fibroids and excessive bleeding are cured.

There are a lot more health benefits women get after getting a radical hysterectomy performed by expert surgeons. Glamyo health has the best surgeons with expertise in different hysterectomy procedures. They provide free gynecologist consultations to all women looking for a solution to their health problems. 

How long is the surgery for a radical hysterectomy?

The time it takes to perform a radical hysterectomy completely depends on the type of advanced technology used to perform the hysterectomy and the perfection of surgeons in their respective fields. 

The estimated time for a radical hysterectomy is one to three hours. The timing of completion of a radical hysterectomy varies with the advancement in technology like robot-assisted and laparoscopic hysterectomy takes lesser time than the traditional method of radical hysterectomy.

Which kind of hysterectomy procedure is best to have?

The best type of hysterectomy to be chosen is the one that is safer than other alternatives, least invasive, and cost-effective. The type of hysterectomy to be chosen also depends on the reason why it is being performed. In case the uterus is removed to treat noncancerous problems, vaginal hysterectomy is chosen among other laparoscopic and abdominal open surgery.

In other cases, laparoscopic hysterectomy is best as it is associated with lesser infection and short hospital stay. Laparoscopic hysterectomy gives comparatively lesser discomfort, and the return to a daily schedule is also faster.

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