Extended extirpation of the uterus according to Wertheim
Extended extirpation of the uterus with appendages is one of the most complex operations in gynecological oncology . The technical complexity of the procedure is due to the removal of not only the uterus, but also the lymphatic vessels, nodes, which are in close relationship with the large vessels of the pelvis. Among other things, during the Wertheim operation, the doctor must manipulate the bladder, ureters and nerve trunks.
An effective treatment for advanced cervical cancer.
During surgery, serious complications can develop: extensive bleeding, dysfunction of the urinary tract and the appearance of fistulas in the postoperative period. Also, with insufficient radicality of the procedure, the number of relapses of the pathology increases. Given these facts, it is extremely important to choose an experienced oncosurgeon to perform the Wertheim operation . It is the professionalism of the doctor that determines the successful outcome of the operation and a favorable prognosis after the treatment of cervical cancer.
Extended extirpation of the uterus is performed at 1, 2 stages of cervical cancer in the absence of metastasis. Surgical treatment in this case is combined with sessions of chemotherapy or radiation therapy. Preoperative irradiation can significantly reduce the biological ability of cancer cells to metastasize.
Radical surgery for cervical cancer
Total hysterectomy (extirpation of the uterus)
During this operation, the surgeon removes the body and cervix. This is the most common surgical intervention in the treatment of cancer of the body and cervix. During the procedure, the appendages, ovaries and fallopian tubes are preserved.
Wertheim operation ( extended hysterectomy )
Wertheim's operation is also called an extended hysterectomy or extirpation of the uterus with appendages, adjacent tissue, lymph nodes and the upper third of the vagina. A rather traumatic surgical intervention, which is performed in the presence of highly differentiated squamous cell carcinoma of the cervix without the presence of metastases and with a depth of germination of no more than 1 cm. The operation can be prescribed for long-term complications after radiotherapy, with relapses of the disease.
Radical hysterectomy
Removal of the cervix and body of the uterus with the ovaries, fallopian tubes, upper part of the vagina and lymph nodes. Indications for radical hysterectomy are endometrial cancer, oncology of the body and cervix.
Technique of the Wertheim operation
Open (cavitary) operation
The operation is performed through an open incision in the anterior abdominal wall. As a rule, it is used in cases where the tumor does not respond to any other treatment. Wertheim's operation with an open (abdominal) method is the most traumatic intervention with heavy blood loss and a long rehabilitation period. Foreign specialists, if possible, refuse the technique of open surgery in favor of laparoscopy.
Laparoscopic hysterectomy
The surgeon removes the uterus using laparoscopic equipment without large incisions in the abdomen. During the operation, the doctor makes several small incisions in the abdominal cavity, through which the tubes are inserted. Further, through the installed tubes, the necessary tools with a video camera are inserted inside. For a better view and the ability to access the uterus, the abdominal cavity is also filled with a special gas that lifts the abdominal wall above the organs. The likelihood of complications during the operation is minimized.
Examination before Wertheim's operation
Immediately before the extirpation of the uterus, the patient undergoes laboratory examinations:
general and detailed blood test (including clotting); Analysis of urine; biopsy; ECG; ultrasound.
Features of the Wertheim operation
Contraindications for extended hysterectomy:
- germination of the tumor deep into the tissues to the walls of the pelvis;
- the presence of severe comorbidities;
- obesity 3-4 degrees;
- elderly age.
Disadvantages of extended hysterectomy:
- high invasiveness of the operation;
- long-term rehabilitation;
- loss of reproductive function;
- for six months, the patient is prohibited from serious physical activity;
- within 6 months it is worth refraining from sexual intercourse.