Radical Hysterectomy

Anesthesia Implications

Position: Supine, Lithotomy, Trendelenburg
Time: 2-4 hours (long)
Blood Loss: High (200 – 500 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Yes

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.

High Blood Loss (general considerations): Type and cross, CBC, and CMP should be done prior to the procedure. Consider having an A-line, blood tubing, and extra push-lines. Depending on the fragility of the patient, you may want to have blood in the room and available.

Long procedure (general considerations): Procedures anticipated to last longer than 2 hours generally require a urinary catheter. Also consider checking lines and positioning regularly as the risks of infiltration and nerve damage are increased with procedure time. Consider an IV fluid warmer and a forced air warmer to keep the patient euthermic.

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.