Approach - GETT. Epidural or spinal analgesia may be used for postoperative pain if it is a laparotomy. Positioning - Steep trendelenburg is typically required during this procedure. Be sure to appropriately position and pad the head, shoulders, and arms. Vagal response - Manipulation of the uterus and surrounding structures can cause a vagal response, with a drop in heart rate/blood pressure. Notify the surgeon if this gets severe. Administration of 0.2 – 0.4 mg of Robinul can often remedy the problem.
Radical hysterectomy is the preferred approach for young women with cervical carcinoma (stage IA, IB, or non bulky IIA) who want to preserve their ovaries. This procedure is also performed for stage II endometrial or stage I vaginal carcinoma.
The uterus, upper vagina, and parametrial tissues are removed. Typically a dissection of the pelvic and paraaortic lymph nodes is performed at the start. This procedure is typically performed either laparoscopically or robotically. If performed laparoscopically/robotically, it should only take about 2-4 hrs with EBL of 100-500mL. However, if it is a laparotomy, it will take 3-6 hrs and EBL will be about 500-1500mL.
