Minimally Invasive Lymph Node Dissection

The lymphatic system

The lymphatic system helps protect us from infection and disease. It is made up of fine tubes called lymphatic vessels. These vessels connect to groups of small lymph nodes throughout the body. The lymphatic system drains lymph fluid from the tissues of the body before returning it to the blood. Lymph nodes are sometimes called lymph glands. They filter bacteria (germs) and disease from the lymph fluid. When you have an infection, lymph nodes often swell as they fight the infection. Sometimes cancer can spread through the lymphatic system. If the cancer cells spread outside the womb, they are most likely to go to lymph nodes in the pelvis (the area between your hips). They may sometimes go to the lymph nodes in the tummy (abdomen).

Removing lymph nodes

The surgeon may remove lymph nodes close to the womb (pelvic nodes) and higher up in the abdomen (para-aortic nodes). This is so they can be checked for cancer cells. How many lymph nodes need to be removed will depend on a case by case basis. In some cases the surgeon will talk to you about removing only 1 or 2 lymph nodes closest to the cancer to check for cancer cells. This is called a sentinel lymph node biopsy. Sometimes it is recommend to remove more lymph nodes during the surgery.

If you are a candidate for surgery, your surgeon may recommend:

Open surgery

The surgeon makes an incision in your tummy large enough to perform the procedure using hand-held tools.

Minimal invasive Surgery (Key-hole surgery)

Key-hole surgery can either be laparoscopic or robotic assisted. This is a surgery that would involve a laparoscope (keyhole camera) inserted through a small cut under the umbilicus (tummy button). Then the surgeon makes several other small cuts in the tummy through which the surgical instruments are inserted.

Laparoscopic assisted surgery

Your surgeons will make small incisions in the tummy and operate using special long-handled tools while viewing magnified images from the laparoscope (camera) on high definition monitors.

Robotic assisted surgery

Your surgeons control a robotic system to perform the procedure.  They will make a few small incisions, and use a 3D High Definition camera for a magnified view of your pelvis and surrounding structures. The surgeon will then sit at a console next to you and operates through the incisions using tiny instruments and the camera.  The robotic system translates your surgeon’s hand movements in real-time, bending and rotating instruments that move like the human hand.

What are the benefits of minimal invasive surgery?

  • Quicker recovery period and faster return to normal activities
  • Reduced pain and discomfort
  • Reduced blood loss
  • Minimal scaring
  • Lower risk of infection
  • Shorter hospital stay

Common complications

Common risks that can occur from this surgery:

  • Anaemia
  • Fatigue/Tiredness
  • Pain/discomfort
  • Bruising
  • Urinary frequency or loss of control

Symptoms to look out for

Due to your shorter hospital stay after laparoscopic surgery, it is very important that you inform us if you develop any problems once you are discharged home.

These can be signs of infection or sepsis, and include:

  • Tummy swelling
  • Pain
  • Fevers
  • Shivers
  • Bleeding from your vagina

Should any of these symptoms develop in the weeks following surgery please contact your Clinical Nurse Specialist or call Ward 26 at the Queen Elizabeth Hospital on 0191 4453004 for advice.

What are other possible risks and complications?

Before you have your surgery, you will be told about the risks and will be asked to sign a consent form which will list the potential complications. Please ask questions at any time. It is important to remember that these risks are uncommon.

The anaesthetist will discuss risks associated with general anaesthetic and pain control after surgery.

Infection– The risk of post-operative infections is reduced by giving antibiotics around the time of surgery, but infection can still sometimes occur in the chest, wound, pelvis or urine. Infections are usually easily treated with antibiotics. Infection happens to 2 women in every 1000.

Bleeding (haemorrhage) – This may occur during the surgery or rarely afterwards. A blood transfusion may be necessary to replace blood lost during the surgery, although this is very unlikely. On very rare occasions there may be internal bleeding which may require a second surgery.

Lymphoedema / lymphocyst formation – you may develop re-accumulation of lymph fluid in your abdomen (tummy) or even in your legs (lymphoedema). This fluid accumulation may resolve over time, but occasionally you may be referred to a specialist Lymphoedema clinic. You can help the lymph fluid circulate and resolve by keeping active after surgery. The risk of developing lymphoedema after removal of pelvic lymph nodes varies from about 2 in every 100 women to 11 in every 100 women according to retrospective studies. The incidence likely varies depending on how much lymphatic tissue was removed.

Clots (thrombosis) – It is possible for clots of bloods to form in the deep veins of the legs and pelvis. This is called a deep vein thrombosis (DVT). This will normally cause pain and swelling in the affected leg and is relatively simple to treat using blood thinning drugs (low molecular weight heparin). In rare cases it is possible for a clot to break away and travel to the lungs. If this occurs, it is a potentially serious complication, but several measures will be taken to reduce the risk of this happening. Moving around as soon as possible after your surgery can help as can wearing special surgical stockings and having injections to thin your blood. 4 women in every 10000 develop blood clots to the legs or lungs after this type of surgery.

Bruising may develop around the wound site which should resolve in a few days. Sometimes patients may develop a hernia over the scar, this is a bulging of the abdominal wall due to muscle weakness after the surgery. This may require further surgical correction. Sometimes you might also experience numbness around the scar area and the top and outside of the legs, this is due to damage of the small nerves. This may resolve with time.

There is a small chance that we may have to convert to open surgery (laparotomy) if the surgery cannot be completed by keyhole surgery or when internal organ injuries occur. There is a risk of bowel and blood vessels injuries (2 in 1000) associated with laparoscopic surgery. If a laparotomy is performed the incision is usually closed with metal clips, which are removed 7 days following surgery, either on the ward or by a District Nurse at home. The ward staff will arrange this prior to discharge.

There is a risk that a small hole can develop in the bladder, or in the ureter (tube which carries urine to the bladder). This may require a further procedure to correct either at the time of the surgery or at a later date. Occasionally, injury is not noted at the time of surgery, particularly if a fistula develops (a connection between the ureter (tubes that drain the bladder) and a nearby organ). If this occurs, you will be referred to a urologist (A Doctor who specialises in urinary problems).

Getting back to Normal

Around the house

While it is important to take enough rest, you should start some of your normal daily activities when you get home and build up slowly. You will find you are able to do more as the days and weeks pass. If you feel pain, you should try doing a little less for another few days. It is helpful to break jobs up into smaller parts, such as ironing a couple of items of clothing at a time, and to take rests regularly. You can also try sitting down while preparing food or sorting laundry. For the first one to two weeks, you should restrict lifting to light loads such as a one litre bottle of water, kettles or small saucepans. You should not lift heavy objects such as full shopping bags or children, or do any strenuous housework such as vacuuming until three to four weeks after your surgery as this may affect how you heal internally. Try getting down to your children rather than lifting them up to you. Remember to lift correctly by having your feet slightly apart, bending your knees, keeping your back straight and bracing (tightening or strengthening) your pelvic floor and stomach muscles as you lift. Hold the object close to you and lift by straightening your knees.


Before you drive you should be:

  • free from the sedative effects of any painkillers
  • able to sit in the car comfortably and work the controls
  • able to wear the seatbelt comfortably
  • able to make an emergency stop
  • able to comfortably look over your shoulder to manoeuvre.

In general, it can take two to four weeks before you are able to do all of the above. It is a good idea to practise without the keys in the ignition. See whether you can do the movements you would need for an emergency stop and a three-point turn without causing yourself any discomfort or pain. When you are ready to start driving again, build up gradually, starting with a short journey

What are the alternatives to not having surgery?

Your decision to not have surgery for your cancer will be respected at all times by your doctor. A meeting to discuss any other options can be arranged.