Having a trachelectomy

Title

Having a trachelectomy for cervical cancer involves tests to check you and fit and well for surgery, deciding how the trachelectomy will be done, and having the surgery.

We know that you may feel nervous about having a trachelectomy or worried about any effects of the treatment. It can help to prepare for any treatment physically, emotionally and practically.

Read about preparing for treatment >

On this page:

Ways a trachelectomy may be done >
Before a trachelectomy >
During a trachelectomy >
After a trachelectomy >
More information and support >

Also in this section:

Ways a trachelectomy may be done

A trachelectomy can be done in different ways. It is important to talk to your healthcare team about how your trachelectomy will be done before the surgery. They can explain any risks and benefits of each option, including how it might affect the time it takes to recover.

In a vaginal trachelectomy, your surgeon removes the cancer through a cut that is made in the top of the vagina.

Research suggests there is a slightly higher risk that not all of the cervical cancer will be removed using vaginal trachelectomy. This may mean you need to have further treatment, which could impact your fertility. However, vaginal trachelectomy may also have fewer side effects and better results for preserving fertility.

Vaginal trachelectomy is sometimes done laparoscopically.

Your surgeon does the operation through small cuts (key holes) in your abdomen. They will use tools that have a tiny camera attached, so that they can see the inside of your body on a screen.

In some hospitals, a robot will assist the surgeon. The surgeon is in the same room but sits away from you and controls the robotic arms to perform the surgery. It allows the surgeon to make more controlled and precise movements. The surgeon is still the one doing the surgery. This is sometimes called robotic trachelectomy.

Recovery after keyhole surgery is usually faster because there is less blood loss. This means your hospital stay may be shorter.

In an abdominal trachelectomy, your surgeon will make an opening either along your bikini line or running down from your belly button. They will remove the cervical cancer through this opening.

An abdominal trachelectomy might be more suitable for you if you have a larger cervical cancer, because the surgeon is more likely to remove all of the cancer. However, some research suggests that there might a lower chance of getting pregnant in the future. You may also have a longer recovery time.

Before trachelectomy

Before trachelectomy, you usually need to have an appointment to check you are fit and well enough for surgery. Your healthcare team will tell you exactly what this will involve, but it may include:

blood tests
checking your blood pressure
assessing any medication you are currently on.

You will be asked to come to the hospital either the day before or on the day of your surgery. Check with your healthcare team when you should arrive.

You will normally have to stop eating at least 6 hours before the surgery. You can usually keep drinking water until 2 hours before the surgery.

Having a general anaesthetic

You will have a general anaesthetic. This means you will be asleep for the surgery and won’t feel anything. Your healthcare team will check you are fit and well enough to have it.

Some people feel worried about having a general anaesthetic. If you feel this way, you could speak to your healthcare team and anaesthetist before, to find out more about what will happen and talk through any concerns.

The anaesthetist will ask you to count to 10 and before you reach 7, you will drift off to sleep. When you wake up, you will be in the recovery room or ward.

During a trachelectomy

The surgeon will remove the cervix, which means the opening to the womb is left. They will put a tight stitch where your cervix was, leaving a small opening for blood flow during your period. If you become pregnant in the future, the stitch is strong enough to reduce the risk of miscarriage or having a baby prematurely.

You may also have the lymph nodes in your pelvis removed to check whether the cancer has spread. Sometimes this will be done before a trachelectomy.

This is normally keyhole (laparoscopic) surgery, where small cuts are made in your abdomen. Find out more about removal of lymph nodes (lymphadenectomy).

A trachelectomy

An illustration of the cervix, top of the vagina and bottom of the womb showing the area that trachelectomy surgery removes.

After a trachelectomy

You will wake up in the recovery room. After the general anaesthetic, you will probably feel very sleepy. You may have:

a clear face mask on – this is providing oxygen to help you breathe comfortably
a drip attached to your hand or arm – this is giving you fluids, so you don’t get dehydrated
dressings on your wounds
a tube in your wound (drain) – this lets blood or fluid can drain away safely and is normally removed after a few days
a thin tube in your bladder (catheter) – this drains your wee into a bag
a drip into your bloodstream – this has pain medication that you can control (PCA or patient controlled analgesia)
a small thin tube put into your back and connected to a pump – this gives you constant pain medication (epidural).

If you had a vaginal trachelectomy, you will have a type of bandage called a gauze pack inside your vagina. This is to help stop any bleeding. It usually stays in place for 24 hours.

Recovering from trachelectomy

You may have to stay in hospital for between 3 to 5 days after having a trachelectomy. Once you are home, you will usually need 4 to 6 weeks to fully recover from a trachelectomy. The exact time will depend on:

any side effects you have
your general health.

Read about recovering from surgery >

More information and support about trachelectomy

Any type of surgery for cervical cancer can have a huge impact on your physical and emotional wellbeing. Your healthcare team, both at the hospital and at your GP surgery, are there to support you with any questions or worries you have.

Remember that we are here for you too, whether you are waiting to have surgery, are in recovery, or are years past it. Our trained volunteers can listen and help you understand what’s going on via our free Helpline on 0808 802 8000.

Check our Helpline opening hours >

Our 1:1 service offers a private way to get support over email, phone call or video call. We can talk through your personal situation, as well as helping you process your feelings and think about next steps. We also welcome partners and family members to use our 1:1 service, so if you are a loved one reading this or think yours would benefit from some extra support, get in touch.

Access our 1:1 service >

Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. You can read through the messages or post your own – whichever feels most comfortable.

Join our Forum >

If you have general questions about surgery for cervical cancer, our panel of medical experts may be able to help. They can’t give you answers about your individual situation or health – it’s best to speak with your GP or healthcare team for that.

Use our Ask the Expert service >

Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it.

References

Nelson, G. et al (2019). Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update. International Journal of Gynecologic Cancer. 29;4. pp.651-668.
Cibula, D. et al (2018). The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer. Radiotherapy Oncology. 127;3. pp.404-416.
Royal College of Obstetricians and Gynaecologists (2013). Fertility Sparing Treatments in Gynaecological Cancers. Scientific Impact Paper No. 35. Web: www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_35.pdf. Accessed October 2020.

We write our information based on literature searches and expert review. For more information about the references we used, please contact info@jostrust.org.uk