Fertility-preserving surgery
Fertility-Sparing Key-Hole Procedures
Specialist surgery designed to treat cancer while preserving the possibility of future pregnancy.
A diagnosis of cervical cancer can be particularly difficult if you are hoping to have children in the future.
For some women with early-stage cervical cancer, it may be possible to treat the cancer while preserving the womb (uterus). This is known as fertility-sparing surgery.
One of the specialist procedures used for selected women is a trachelectomy, which removes the cervix while leaving the womb in place. In appropriate patients, this can provide an alternative to a hysterectomy and means that pregnancy may remain possible after treatment.
At Gynae Solution, Mr Jafaru Abu has a specialist interest in fertility-preserving surgery and minimally invasive, keyhole techniques for gynaecological cancer.
Our approach is to make sure you understand not only the treatment itself, but also how it may affect your fertility, pregnancy and future health.
What is fertility-sparing surgery?
Fertility-sparing surgery is treatment designed to remove the cancer while preserving the organs needed for a future pregnancy wherever this is medically safe and appropriate.
For selected women with early cervical cancer, this may involve removing the cervix rather than the entire womb.
The operation is called a trachelectomy.
The womb remains in place, meaning that pregnancy may be possible in the future. However, fertility-sparing treatment is only suitable for certain cancers, and preserving fertility must never compromise effective cancer treatment.
Your treatment will be carefully planned according to the type, size and location of your cancer, its stage and whether there is any evidence that it has spread.
What is a trachelectomy?
A trachelectomy is an operation to remove the cervix.
The cervix is the lower part of the womb that connects the womb to the vagina. During a trachelectomy, the cervix is removed while the main body of the womb is preserved.
Depending on the type of cancer and the surgical approach required, the operation may also involve removing:
- Tissue surrounding the cervix, known as the parametrium
- The upper part of the vagina
- Lymph nodes in the pelvis
The exact operation depends on your individual circumstances and the extent of the cancer.
The aim is to remove the cancer completely while preserving the womb whenever this can be achieved safely.
Who may be suitable for fertility-sparing surgery?
Not everyone with cervical cancer will be suitable for a trachelectomy.
Fertility-sparing surgery is generally considered for carefully selected women with early-stage cervical cancer where there is a reasonable expectation that the cancer can be completely removed while leaving the womb intact.
Your specialist team may consider factors including:
- The stage of your cervical cancer
- The size of the tumour
- The exact location of the tumour
- The type and grade of the cancer
- Whether the lymph nodes are affected
- Whether there is evidence of cancer outside the cervix
- Your general health
- Your wishes regarding future fertility
Historically, trachelectomy has most commonly been considered for small tumours, often measuring 2cm or less. However, suitability is not determined by tumour size alone, and current specialist assessment is individualised.
Your cancer will usually be discussed by a specialist multidisciplinary team before a recommendation is made.
Why might fertility-sparing surgery be considered?
A standard hysterectomy removes the womb and means that carrying a pregnancy is no longer possible.
For women who wish to have children in the future, preserving the womb can therefore be extremely important.
A trachelectomy may offer selected women the opportunity to receive surgical treatment for cervical cancer while retaining their uterus.
However, fertility preservation is only considered when it is compatible with safe and effective cancer treatment.
Your consultant will discuss the potential benefits and limitations with you so that you can make an informed decision.
What are the different types of trachelectomy?
There are several approaches to trachelectomy.
Simple trachelectomy
A simple trachelectomy involves removing the cervix while leaving the surrounding parametrial tissue and upper vagina intact.
This may be appropriate for selected small, early cervical cancers.
Radical trachelectomy
A radical trachelectomy is a more extensive operation.
It removes:
- The cervix
- The tissue surrounding the cervix (parametrium)
- Part of the upper vagina
The womb itself is preserved.
Depending on the cancer and the planned treatment, pelvic lymph nodes may also be removed to check whether the cancer has spread.
Lymph-node surgery
Lymph nodes form part of the body's drainage and immune system.
During fertility-sparing treatment, lymph nodes in the pelvis may need to be removed and examined to establish whether there is any evidence of cancer spread.
This information is important when determining whether fertility-sparing surgery remains an appropriate treatment option.
What is keyhole trachelectomy?
A keyhole, or laparoscopic, trachelectomy is performed through several small incisions rather than one large abdominal incision.
A small camera called a laparoscope is inserted through one of the incisions. The surgeon can see highly magnified images of the pelvic organs on a screen while using specialised instruments through the other small incisions.
For some patients, a robotic system may also be used to assist with the operation.
The surgeon remains in control of the procedure; robotic technology provides highly precise instrument movement and visualisation.
Mr Abu has specialist experience in complex laparoscopic gynaecological surgery, including fertility-sparing procedures.
What are the advantages of a keyhole approach?
Where laparoscopic surgery is appropriate, the minimally invasive approach may offer several benefits compared with traditional open surgery.
These can include:
- Smaller abdominal incisions
- Less visible scarring
- Less blood loss
- Reduced postoperative discomfort
- A shorter hospital stay
- Faster recovery
- Earlier return to normal activities
The suitability of keyhole surgery depends on your individual circumstances. The priority is always safe and complete cancer treatment rather than using a particular surgical technique at all costs.
What happens before surgery?
Before fertility-sparing surgery, you will have a detailed assessment to establish whether this approach is appropriate for you.
This may involve reviewing:
- Your biopsy results
- MRI or other imaging
- The size and location of the tumour
- Your cancer stage
- Lymph-node status
- Your general health
- Your previous medical history
- Your fertility plans
Your case may be discussed by a specialist gynaecological oncology multidisciplinary team.
You will have the opportunity to discuss the proposed operation, alternative treatments, potential risks and what the treatment could mean for your future fertility.
What happens during a keyhole trachelectomy?
The operation is performed under a general anaesthetic, so you will be asleep throughout.
Several small incisions are made in the abdomen. Carbon dioxide is used to gently inflate the abdomen, creating space for the surgeon to operate.
A camera provides a magnified view of the pelvis while specialised instruments are used to remove the affected tissue.
Depending on your procedure, the surgeon may remove:
- The cervix
- Surrounding tissue
- Part of the upper vagina
- Pelvic lymph nodes
The remaining womb is then carefully preserved.
The exact surgical technique will be explained to you before your operation so that you understand what is planned and why.
Could the operation need to be changed?
Although your treatment will be carefully planned before surgery, the surgeon may occasionally discover information during the operation that changes what can safely be achieved.
For example, if there is evidence that the cancer has spread beyond what was expected, fertility-sparing surgery may no longer be appropriate.
In some circumstances, the operation may need to be changed to a different cancer treatment, such as a hysterectomy or another form of treatment.
This possibility will be discussed with you before surgery so that you understand the potential options.
The overriding priority is always to provide effective cancer treatment while preserving fertility where this can be achieved safely.
Can I become pregnant after a trachelectomy?
Because the womb is preserved, pregnancy may be possible after a trachelectomy.
However, fertility cannot be guaranteed.
The surgery itself can affect fertility, and cervical cancer or other treatments may also have an impact. Your individual chances will depend on your age, fertility before treatment, the type of surgery and whether you require additional treatment such as chemotherapy or radiotherapy.
You should discuss your fertility plans with your specialist team before treatment begins.
If your cancer treatment is expected to affect fertility, you may also be referred to a fertility specialist to discuss fertility-preservation options. These can include egg or embryo freezing in appropriate circumstances.
What is pregnancy like after a trachelectomy?
Pregnancy following a trachelectomy is considered higher risk and requires specialist obstetric care.
Because the cervix has been removed or shortened, there is an increased risk of complications such as premature birth.
If you become pregnant following fertility-sparing surgery, your obstetric team will monitor you carefully throughout the pregnancy and discuss the appropriate plan for delivery.
Your specialist team will explain these considerations before surgery so you understand not only the potential opportunity for future pregnancy, but also the additional care that may be required.
What are the risks of fertility-sparing surgery?
As with any major operation, a trachelectomy carries potential risks.
These can include:
- Bleeding
- Infection
- Blood clots
- Injury to the bladder, bowel, ureters or other surrounding structures
- Problems passing urine
- Changes in bladder or bowel function
- Lymphoedema following lymph-node surgery
- Anaesthetic complications
- The need for further surgery or treatment
There are also specific considerations relating to fertility.
Although the aim is to preserve the possibility of pregnancy, fertility cannot be guaranteed, and some women may subsequently require assisted conception.
There is also a possibility that additional treatment may be required if cancer is found in the lymph nodes, if the tumour cannot be completely removed or if the cancer returns.
Your individual risks will be discussed in detail before you make a decision about treatment.
What is recovery like?
Recovery depends on the exact type of trachelectomy performed and whether lymph-node surgery or other procedures are required.
Keyhole surgery generally allows a quicker recovery than traditional open abdominal surgery.
After the operation, you will be monitored in hospital and given appropriate pain relief. You will gradually be encouraged to move around and return to eating and drinking as your recovery progresses.
You may experience:
- Tiredness
- Abdominal discomfort
- Bloating
- Mild vaginal bleeding or discharge
- Temporary changes in bladder or bowel function
Your surgeon will give you specific advice about wound care, exercise, driving, work and sexual activity.
It is important to allow your body time to heal rather than rushing your recovery.
Will I still have periods after a trachelectomy?
Because the womb is preserved, women who have not reached menopause may continue to have periods following a trachelectomy.
However, your periods may change following surgery.
Your consultant can explain what you may expect based on the particular procedure you are having.
Will I need further treatment?
That depends on the results of your surgery and the characteristics of your cancer.
The tissue removed during surgery is examined by specialist pathologists. The results help confirm whether the cancer has been completely removed and whether any further treatment is required.
Some women may require additional treatment such as chemotherapy or radiotherapy depending on the findings.
Your ongoing treatment and follow-up will be planned by your specialist multidisciplinary team.
What if fertility-sparing surgery isn't suitable for me?
If a trachelectomy is not considered safe or appropriate, this does not mean that your concerns about fertility are being overlooked.
Your consultant will explain why the procedure is not suitable and discuss the alternatives available.
Depending on your diagnosis, treatment may involve surgery, chemotherapy, radiotherapy or a combination of treatments.
If treatment is likely to affect your fertility, you may be offered a referral to a fertility specialist to discuss preservation options before cancer treatment begins, where clinically appropriate.
The most important consideration is treating the cancer effectively. Fertility preservation should be considered alongside this, rather than at the expense of effective cancer treatment.
Specialist fertility-sparing surgery at Gynae Solution
Being diagnosed with cervical cancer when you still hope to have children can make treatment decisions particularly emotional and difficult.
At Gynae Solution, we understand that your priorities extend beyond treating the cancer itself.
Mr Jafaru Abu has a specialist interest in gynaecological oncology, minimally invasive surgery and fertility-sparing procedures. He will take the time to understand your diagnosis, your future plans and your concerns before discussing the most appropriate treatment options.
Where fertility-sparing surgery is appropriate, the aim is to provide effective cancer treatment while preserving the womb and the possibility of future pregnancy.
Every patient is different, and your treatment will be tailored to your individual circumstances.
Discuss your options
If you have been diagnosed with early-stage cervical cancer and are concerned about how treatment may affect your fertility, a specialist consultation can help you understand your options.
Book a consultation with Mr Abu to discuss whether fertility-sparing surgery or a keyhole trachelectomy may be appropriate for you.
Patient leaflets
Written for patients, relatives and hospital personnel, to read before your operation and to keep afterwards.
Common questions
How soon can I be seen?
Daily appointments are available at The Park Hospital. Call the secretary on 0115 966 2049, or send an enquiry below and we will reply within 24 hours on business days.
Do I need a GP referral?
Referrals from GPs are welcome, and you can also enquire directly. If you are using private medical insurance, check with your insurer whether a referral is required for your policy. See GP referrals and fees and insurance.
What does a consultation cost?
A new consultation is £250 and a follow-up consultation is £150. The cost of any tests, procedures or surgery is quoted individually after your consultation. See fees and insurance.
Enquiries
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Enquiries from patients and referring clinicians are both welcome. We endeavour to answer all enquiries within 24 hours on business days. If your case is urgent, please say so in your message or call the secretary directly.