Introduction:
Laparoscopic surgery is a surgical technique that is minimally invasive and is used to view the inside of the body without creating a big opening. The abdominal and pelvic cavities are viewed clearly through small keyhole incisions. Cervical cancer is cancer (uncontrollable growth of cells that may spread to other body parts) that occurs in the cells of the cervix, which is the narrow lower part of the uterus. Laparoscopic surgeries have been beneficial in carrying out radical hysterectomies (surgery that is used to remove the cervix, uterus, part of the vagina, and structures around these organs) in women suffering from early-stage cervical cancer for an extended period.
What Is Laparoscopic Surgery?
Laparoscopic surgery is a type of surgical technique in which the doctor uses a laparoscope (a thin rod with light and a camera at the end) to access the abdominal and pelvic areas through tiny incisions. Open abdominal surgery requires incisions that are six to twelve inches in dimension, whereas laparoscopic surgery uses incisions that are half an inch or less. Since laparoscopic surgery makes use of tiny incisions, it is also known as keyhole surgery.
What Is Cervical Cancer?
Cervical cancer is a kind of cancer that begins in the cells of the cervix. The cervix is the lower portion of the uterus that connects the upper portion of the uterus to the vagina. Cervical cancer develops gradually over time. Initially, the cells of the cervix undergo a few changes, followed by the appearance of abnormal cells in the cervical tissue. Over time, these abnormal cells change into cancer cells and spread deeply into the cervix and neighboring areas. Human papillomavirus (HPV), which is a virus transmitted through sexual contact, is the main cause of cervical cancer.
What Are the Symptoms of Cervical Cancer?
Cervical cancer does not show many symptoms in the early stage. However, symptoms begin to appear as the disease progresses into the advanced stage. They are as follows:
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Pelvic pain.
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Vaginal bleeding occurs after sexual intercourse (between periods or after menopause).
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Bloody and watery vaginal discharge.
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Pain felt during sexual intercourse.
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Severe foul-smelling vaginal discharge.
How Is Cervical Cancer Treated?
The treatment of cervical cancer is mainly based on the stage of cancer and the preference of the patient. Surgery, radiation, chemotherapy, or a combination of the three may also be used.
Surgery:
Surgery has been the most widely used treatment for early-stage cervical cancer. The different types of surgical procedures involved in the treatment of cervical cancer are as follows:
- Cold Knife Conization:
Cold knife conization is the surgical method in which a cone-shaped piece of tissue is removed from the cervix and cervical canal using a scalpel (a bladed surgical instrument). This type of surgery is useful for small cervical cancer in which the cancerous tissue alone is removed, leaving the rest of the cervix intact.
- Cryosurgery:
Cryosurgery involves the placement of a very cold metal probe on the cervix. This method freezes and kills cancer cells.
- Laser Ablation:
This method involves directing a focused beam of the laser through the vagina, which burns off the cancer cells present in the cervix.
- Trachelectomy:
A trachelectomy is a surgical approach that involves the removal of the cervix and upper part of the vagina, leaving the body of the uterus intact. The benefit of this method is that the women undergoing this procedure would not lose their ability to have children.
- Hysterectomy:
Hysterectomy is a surgical procedure that is used to remove the uterus. However, when a hysterectomy is used as a method to treat cervical cancer, the cervix, and the surrounding tissues are also removed. There are three main types of hysterectomy, namely total hysterectomy, radical hysterectomy, and modified radical hysterectomy. Total hysterectomy involves the removal of the uterus and the cervix. Radical hysterectomy involves the removal of the cervix, uterus, part of the vagina, and surrounding tissues. Modified radical hysterectomy involves the removal of the cervix, uterus, upper part of the vagina, and tissues surrounding these organs.
What Is the Role of Laparoscopic Surgery in Cervical Cancer?
Laparoscopic surgery plays an important role in the surgical management of cervical cancer as it offers many advantages compared to open surgeries.
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Laparoscopic Surgical Procedure:
The surgical procedure usually begins with a small incision near the pelvic bone or belly button. The first incision is used to pump carbon dioxide gas into the pelvic or abdominal cavity. During the surgery, thin surgical tubes called trocars are used. These trocars act as a pathway for introducing surgical instruments into the abdominal or pelvic cavity. The surgeon will insert the gas tube through the first trocar to inflate the pelvic or abdominal cavity with gas. This separates the abdominal wall from the organs making easier visualization of the organs on the video monitor. After inflating the abdominal or pelvic cavity, the surgeon would introduce the laparoscope through the trocar after removing the gas tube. The laparoscope would project video images of the surgical site on the monitor, which acts as a guide in placing the surgical instruments. The number of keyhole incisions would increase depending on the type of procedure and the placement of trocars. In some cases, a surgical drain may be kept inside the abdominal cavity to drain out the excess fluid during the procedure. In some patients, the surgical drain would continue to remain in the body to drain out the fluid after the surgery. Finally, the gas would be pushed out of the body, and the incisions would be closed.
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Laparoscopic Hysterectomy:
This surgical procedure involves the removal of the uterus through laparoscopy. The laparoscope (a thin tube with a video camera at the end) is inserted through the tiny surgical incisions made on the abdominal wall to see the abdomen and pelvis. The surgeon can cut around the uterus using small instruments controlled through the tubes without making a large cut in the abdomen. Finally, the uterus is removed through a cut made in the vagina.
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Laparoscopic Radical Hysterectomy:
Laparoscopic radical hysterectomy results in less pain, less blood loss, and reduced hospital stay compared to open surgery. This procedure is done similarly to laparoscopic hysterectomy and may remove fallopian tubes, nearby lymph nodes, and ovaries along with the uterus, the upper part of the vagina, and the cervix.
Conclusion:
Some studies have shown that laparoscopic hysterectomy may be less effective than traditional hysterectomy since cervical cancer recurrence is seen more in laparoscopic hysterectomy than traditional hysterectomy. However, considering the benefits like minimal pain, fast recovery, and short hospital stay, many people with cervical cancer opt for laparoscopic surgery. However, the patient has to enquire about the benefits and risks before the procedure and choose the right option.
