Surgery for Vulvar 슬롯 사이트

The following types of surgery are listed in order of how much tissue is removed from the vulva (from least to most):

Laser surgery for vulvar cancer

For treatment of VIN (vulvar intraepithelial neoplasia, a pre-cancer), a laser beam can be used to burn off the layer of vulvar skin with abnormal cells. Laser surgery is not used to treat invasive cancer.

Vulvar cancer excision

During an excision, the cancer cells, surrounding edge (margin) of normal, healthy tissue (usually at least ? inch), and a thin layer of fat below the cancer cells are cut out). This is sometimes called wide local excision.

Vulvectomy

In this type of operation, all or part of the vulva is removed.

• Partial vulvectomy removes only part of the vulva. Doctors use it to treat small tumors or precancerous spots. It might take out part of the labia minora, labia majora, or clitoris, depending on where the tumor is.
• Simple vulvectomy removes the entire vulva, including the labia minora, labia majora, and clitoris. It does not remove deeper tissues or lymph nodes.
• Radical partial vulvectomy removes part of the vulva along with deeper tissues.
• Radical complete ulvectomy removes the entire vulva and some deeper structures, which may include part of the vagina or perineum.

Reconstruction after vulvectomy

Sometimes these procedures remove a large area of skin from the vulva, requiring skin grafts from other parts of the body to cover the wound. However, most  surgical wounds can be closed without grafts and still provide a very satisfactory appearance. If a skin graft is needed, the gynecologic oncologist may do it. Otherwise, it may be done by a plastic/reconstructive surgeon after the vulvectomy.

Reconstructive surgery is available for women who have had more extensive surgery. A reconstructive surgeon can take a piece of skin and underlying fatty tissue and sew it into the area where the cancer was removed. Several sites in the body can be used, but the blood supply to the transplanted tissue needs to be kept intact. This is where a skillful surgeon is needed because the tissue must be moved without damaging the blood supply. If you're having flap reconstruction, ask the surgeon to explain how it will be done, because there's no set way of doing it.

Pelvic exenteration for vulvar cancer

Pelvic exenteration is a major surgery used to treat advanced or returning vulvar cancer that has spread to nearby organs. It is considered when:

• The vulvar cancer has spread to the bladder, rectum, or nearby organs.
• The vulvar cancer returns after previous treatments.
• Radiation and chemotherapy have not been effective.

In this surgery, multiple organs in the pelvis may be removed, depending on how far the cancer has spread. This can include the vulva, vagina, bladder, rectum, or part of the colon. If the bladder is removed, a urostomy may be necessary to urinate.  If the rectum or colon is removed, a colostomy may be necessary to help the body remove fecal waste. Doctors may also take out nearby lymph nodes to check if the cancer has spread further.

Recovery after pelvic exenteration can be challenging and will involve reconstructive surgery to restore body functions. Some patients will need a colostomy or urostomy to help with waste elimination, while others may choose vaginal reconstruction for comfort and confidence. Because this surgery has a major impact on daily life, emotional and psychological support is important for recovery.

Lymph node surgery for vulvar cancer

Because vulvar cancer often spreads to lymph nodes in the groin, these may need to be removed. Surgery to remove lymph nodes is called a lymphadenectomy. Treating the lymph nodes is important when it comes to the risk of cancer coming back and long-term outcomes. Still, there's no one best way to do this. Talk to your doctor about what's best for you, why it's best, and what the treatment side effects might be.

Inguinal lymph node dissection

Surgery to remove lymph nodes in the groin is called an inguinal lymph node dissection. Usually, only lymph nodes on the same side as the cancer are removed. If the cancer is in or near the middle, then both sides may have to be done.

In the past, the incision (cut in the skin) that was used to remove the cancer in the vulva was made larger to remove the lymph nodes, too. Now, doctors remove the lymph nodes through a separate incision about 1 to 2 cm (less than ? to 1 inch) below and parallel to the groin crease. The incision is deep, down through membranes that cover the major nerves, veins, and arteries. This exposes most of the inguinal lymph nodes, which are removed as a solid piece. A major vein, the saphenous vein, may or may not be closed off by the surgeon. Some surgeons will try to save the saphenous vein to reduce leg swelling (lymphedema) after surgery.  However, other surgeons may not try to save it since lymph node removal is the major cause of the lymphedema.

After the surgery, a drain is placed into the incision and the wound is closed. The drain stays in until not much fluid is draining.

Sentinel lymph node biopsy

This procedure can help some women avoid having a full inguinal node dissection. It's used to find and remove the lymph nodes that drain the area where the cancer is. These lymph nodes are known as sentinel lymph nodes because cancer would be expected to spread to them first. The removed lymph nodes are then looked at under the microscope to see if they have cancer cells. If they do, the rest of the lymph nodes in this area need to be removed. If the sentinel nodes do not have cancer cells, further lymph node surgery isn't needed. This procedure can be used instead of an inguinal lymph node dissection if there's no obvious lymph node spread.

To find the sentinel lymph node(s), radioactive material and/or blue dye is injected into the tumor site the day before surgery. The groin is scanned to identify the side (left or right) that picks up the radioactive material. This is the side where the lymph nodes will be removed. During the surgery to remove the cancer, blue dye will be injected again into the tumor site. This allows the surgeon to find the sentinel node by its blue color and then remove it. Sometimes 2 or more lymph nodes turn blue and are removed.

Complications and side effects of vulvar surgery

Vulvar surgery, such as vulvectomy or reconstruction, can cause short-term and long-term side effects. The side effects depend on how much tissue is removed and how well the body heals. Good hygiene and careful wound care are important.

Short-term side effects

• Pain and swelling are common for the first few weeks.
• Infection can happen, especially in warm, moist areas.
• Bleeding or bruising may cause swelling or discomfort.
• Blood clots may form due to less movement after surgery.

Long-term side effects

• Lymphedema (swelling) can develop when lymph node removal results in poor fluid drainage from the legs. Information about lymphedema and how to manage it can be found in Lymphedema.
• Problems with urination or bowel movements can occur if nearby tissues are affected.  For example, the urine stream might go to one side because tissue on one or both sides of the urethral opening has been removed.
• Sexual changes can happen after vulvar surgery.  Since the outer genitals, especially the clitoris, are important for pleasure, it may be harder to reach orgasm.  Scar tissue can sometimes make the vaginal opening smaller, which can cause pain during sex. Vaginal dilators may help stretch the area, and if scarring is severe, skin grafts can widen the opening. Pelvic floor therapy can also help improve comfort and muscle function. For more information, see How 슬롯 사이트 Surgery Can Affect Sex for Women.
• Emotional struggles can affect confidence and intimacy.