Perioperative management - pelvic lymphadenectomy on both sides, laparoscopic, robot-assisted laparoscopy (DaVinci)

Gynecological History:

• Initial symptoms (e.g., postcoital or atypical bleeding, pain, vaginal discharge)
• Menstrual cycle, number of pregnancies/births
• Previous gynecological diseases or procedures
• HPV status and PAP smears

General Medical History:

• Pre-existing conditions (e.g., cardiovascular, pulmonary, endocrine diseases)
• Infections, autoimmune diseases
• Previous surgeries, especially in the abdomen/pelvis
• Medication history (e.g., anticoagulants, immunotherapy, hormone therapy)

Oncological History:

• Stage and histology of cervical cancer (FIGO classification)
• Previous chemotherapy or radiation therapy

General Status:

• Vital parameters (BP, HR, temperature, respiratory rate)
• General condition, nutritional status

Gynecological Examination:

• Speculum setting: Inspection of the cervix and vagina for tumor or ulcerations
• Bimanual examination: Assessment of tumor mobility and infiltration
• Transvaginal sonography for uterine and adnexal tumor evaluation
• Rectovaginal examination to assess possible parametrial infiltration

Lymph Node Status:

• Palpation of the inguinal, supraclavicular, and axillary lymph nodes

Imaging for Staging Diagnostics:

• Pelvic MRI (Assessment of local tumor extent)
• CT Thorax/Abdomen/Pelvis (Exclusion of distant metastases)
• possibly PET-CT (in case of unclear lymph node involvement)
• Urological Diagnostics:
  • possibly Cystoscopy if bladder infiltration is suspected
  • possibly Ureteral Ultrasound or CT Urogram for assessment of the ureters

Patient Education and Consent:

• Risk disclosure regarding bleeding, infections, nerve damage, thrombosis, lymphoceles
• Discussion of alternatives (e.g., radiochemotherapy)

Optimization of General Condition:

• Correction of electrolyte disturbances and anemia (e.g., iron infusion)
• Adjusting or pausing anticoagulant medications
• Nicotine abstinence at least 2 weeks preoperatively

Thrombosis Prophylaxis:

• Start with low molecular weight heparin (LMWH) on the evening before surgery

Bowel Preparation:

• Light diet the day before, possibly laxative

Antibiotic Prophylaxis:

• 30–60 minutes before skin incision second-generation cephalosporin (e.g., cefuroxime 1.5 g i.v.) and metronidazole

Perioperative Pain Management:

• Multimodal analgesia with paracetamol/metamizole, NSAIDs, possibly opioids

Laboratory Diagnostics:

• Blood count, coagulation, electrolytes, kidney and liver values
• Tumor markers: possibly SCC (squamous cell carcinoma), possibly CEA
• Infection serology (HIV, Hepatitis B/C, Syphilis)

Monitoring in the intensive care unit or IMC for unstable patients

Regular monitoring of:

• Vital parameters (BP, HR, SpO₂, temperature)
• Drainage amount and quality (bleeding, lymphatic fistulas)
• Urine output via bladder catheter
• Signs of ureter or bladder injury (hematuria, dysuria)

Thrombosis prophylaxis:

• Continuation of LMWH and compression stockings

Pain management:

• PCA pump (patient-controlled analgesia) or opioids as needed

Nutrition and mobilization:

• Early oral fluid intake (provided there are no signs of ileus)
• Early mobilization from the 1st postoperative day

Wound and Drain Management:

• Remove drains after 2–5 days if secretion <50 ml/day
• Monitor for lymphoceles (ultrasound control if necessary)

Urinary Catheter Management:

• Remove after 1-3 days if no urinary retention

Thrombosis Prophylaxis:

• LMWH for at least 4 weeks postoperatively

Early Physiotherapy and Lymphatic Drainage:

• To reduce lymphedema
• Mobilization to prevent thrombosis

Gynecological Follow-up:

• First check-up after 4 weeks
• Regular gynecological examinations every 3–6 months in the first 2 years

Lifestyle and Behavioral Recommendations:

• Avoid heavy lifting (>5 kg) for 6–8 weeks
• No sexual intercourse for 4–6 weeks
• Inform about possible complications (lymphedema, dysuria, sexual dysfunction)