Laparoscopic pelvic
lymph node dissection
This information sheet has been written to explain your operation. The medical and nursing staff
will be pleased to answer any questions you may have.
What is a laparoscopic pelvic lymph node dissection?
It is the removal of lymph nodes that are situated around the reproductive organs in the pelvis.
Lymph nodes, sometimes called glands, act as a filter in your body and can be a collection site
for tiny (microscopic) cancer cells. The procedure is carried out using an instrument called a
laparoscope, which is a type of small telescope.
Why do I need this operation?
You have been given a diagnosis of cancer of the cervix. This operation is recommended in
2 options depending on the stage of your cancer. Your consultant will discuss with you the
option that applies to you.
Option 1
Patients with very early stage cancer (stage 1a/1b1) of the cervix who want to have children in
the future. This would involve removal of the pelvic lymph nodes and an operation called a
radical trachelectomy. A trachelectomy is an operation to remove the cervix but leaving the
womb (uterus) to allow for the possibility of future pregnancies.
Option 2
Patients with an area of disease that is slightly larger (stage 1b1/1b2), or for whom fertility is not
an issue, may require surgical treatment in 2 stages.
Stage 1
The lymph glands are removed and then looked at in the laboratory to see if there are
cancer cells present.
Stage 2
If the glands are clear of cancer you will have a further operation to remove your uterus,
cervix, fallopian tubes and upper third of the vagina and possibly your ovaries (radical or
Werthiems hysterectomy). This operation will be done within 1 week after removal of your
lymph nodes.
However, if the glands are found to have cancer cells in them, then the recommended
treatment is a combination of radiotherapy (x-ray treatment) and chemotherapy (drug
treatment) rather than a radical hysterectomy.
What are the benefits of this operation?
Patients whose cancer is slightly more advanced will avoid unnecessary major surgery if the
nodes show cancer cells and instead receive the more appropriate treatment of chemotherapy
and radiotherapy.
What are the risks, consequences and alternatives associated with this
operation?
Most operations are straight forward, however as with any surgical procedure there is a small
chance of side-effects or complications such as:
Excessive bleeding.
Damage to the bowel, bladder, ureters (tubes from kidneys to bladder) and blood
vessels.
You may also have some pelvic nerve damage as a result of your operation, you may
experience numbness to your abdomen or thighs.
Other rare risks include anaesthetic complications and clots in the veins and lungs in the days
following surgery. Giving injections of enoxaparin under the skin during your hospital stay
reduces this risk, as it thins the blood slightly without significantly increasing the risk of bleeding.
If such complications do occur, the doctor may decide to perform a laparotomy. This involves a
larger cut to your abdomen.
To reduce the risk of developing an infection, you will be given antibiotics through a drip
(intravenously) during the operation. If you are concerned about any of these risks, or have any
further queries, please speak to your consultant.
Alternatives
Your consultant has recommended this procedure as being the best option. However, the
alternative to this procedure is using open surgery that will involve having a cut to your
abdomen. If you would like more information please speak to your consultant or one of the
nurses caring for you.
There is also the option of not receiving any treatment at all. The consequences of not receiving
any treatment are that your problems/disease may continue or worsen. If you would like more
information please speak to your consultant or one of the nurses caring for you.
Getting ready for the operation
A few days before your admission to hospital, you will be asked to attend the pre-operative
assessment clinic. A nurse will discuss the operation with you. You may need to undergo some
routine tests before your operation eg. x-ray, blood tests.
You will be asked some routine questions about your general health, the medicines you take at
the moment and any allergies you have.
You will be asked to sign a consent form with your consultant to say that you understand what
you have come into hospital for and what the operation involves.
On the day of your operation
For a time before certain types of anaesthetic you will need to stop eating, drinking and chewing
gum. This will be explained to you and you may also be given a booklet about this. If you have
any questions please contact the hospital - telephone number on your admission letter.
You will be asked to have a bath or shower before coming into hospital.
On admission
When you arrive on the ward you will be introduced to the staff and taken to the Day Case Unit
where your details (name, date of birth etc) will be checked on a number of occasions before
the operation. This is normal practice and is for your safety. You will be given an operation
gown and a wristband to wear. You will also see your consultant.
A nurse or porter will take you to the anaesthetic room.
What sort of anaesthetic will I have?
Your operation will be carried out under general anaesthetic, which means you will be asleep
throughout. The anaesthetist will visit you before your operation and discuss the anaesthetic
with you.
How is the operation performed?
The operation is done using an instrument called a laparoscope, which is a type of small
telescope, connected to a television screen that enables the surgeon to see inside your
abdomen (tummy). To remove the nodes, 4 small cuts are made in the lower part of your
abdomen. Gas is inserted into your abdomen causing it to swell - this allows a clearer view.
Further instruments are then used to remove the nodes. The gas is released at the end of the
operation. The cuts are closed with a clip or a stitch and covered with a small dressing. Stitches
are usually dissolvable. The operation takes approximately 1½ - 2 hours.
What should I expect following my operation?
When the operation is over you will have your pulse, blood pressure, breathing and wounds
checked regularly by a nurse.
It is usual to feel drowsy for several hours. You may be given oxygen through a face mask until
you are more awake.
You may have a drip running into the vein in your arm/hand until you are eating and drinking
again. You should be able to eat and drink approximately 6 hours after the operation.
Anaesthetics can sometimes make you feel sick. The nurse can give you an injection to help
control this.
You may have some pain after the operation. Painkillers can be given to help and it is important
you let your nurse know if you have any pain.
Depending on the length of your operation you may have a urinary catheter in place. This is a
small tube to drain the bladder. A nurse will remove it the following morning.
You may bleed after the operation, similar to a period. This will gradually decrease and change
to a brown discharge - you will need to wear a sanitary pad (not tampons).
This bleeding/discharge may last up to 4 weeks.
After several days you may have some leakage of clear fluid from the vagina, it may look similar
to urine. This is often due to lymphatic fluid (which the lymph nodes would normally filter)
coming away. Provided that you are passing good volumes of urine without a problem this is
nothing to worry about and this usually stops approximately 3 - 4 weeks after the operation. If
you think this is happening and you are concerned please inform your consultant at your follow
up appointment.
Getting out of bed
It is important to get out of bed and take a short walk on the same day or the day after your
operation. This helps reduce the risk of blood clots forming in the veins or lungs. You will be
given an exercise sheet to follow, which includes deep breathing and leg exercises.
Having a bath or shower
A nurse will help you have a shower the day after your operation. A daily shower or bath is
advisable to help healing.
Dressings
The dressings or plasters may be removed the morning after your operation. Plasters may be
needed if oozing persists. The day after your operation you may have a bath or a shower.
Going home
You will normally be allowed home after 1 - 2 days.
Driving
The usual recommended time to start driving again is 2 weeks following surgery. This may
depend on how your wound heals and you may not feel comfortable to drive for at least
6 weeks. Please check with your insurance company. Your insurance company may refuse to
meet a claim if they feel you have driven too soon.
When will I know if further treatment is needed?
The results from your operation can take approximately 1 week and will not be available before
you leave hospital.
You will be provisionally booked for further surgery the following week, however this final
decision will depend on the laboratory results.
You will need to be seen in outpatients the following week to discuss your results and will be
advised if you are to have surgery or treatment with radiotherapy and chemotherapy.
If you have any queries, or require further information
please contact the Gynaecology Clinical Nurse Specialists on 01332 785925,
available Monday to Friday, 9.00am - 5.00pm (answer phone is available).
Alternatively contact Ward 209a, on 01332 785617 or 01332 785017.
Reference Code: P0901/1553/01.2013/VERSION1
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