The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Laparoscopic radical hysterectomy for early stage cervical cancer in May 2010. NICE is currently updating this guidance. The new guidance will be published shortly. Until then the NHS should continue to follow the recommendations outlined in the current version of the guidance. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure review and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland. The Committee discussion on 12th December 2019 has been postponed. During the consultation, comments were received suggesting there is additional evidence for the procedure and the Interventional Procedures Programme require additional time to review this information. We anticipate the Committee discussion will be rescheduled to 16 January 2020.
 
Status In progress
Process IP
ID number 51
Description Minimally invasive radical hysterectomy for early stage cervical cancer is done using general anaesthesia. A uterine manipulator is inserted through the vagina, and attached to the uterus and cervix. The abdomen is insufflated with carbon dioxide, and several small incisions are made to provide access for the laparoscope and surgical instruments. A robot may be used to assist with the procedure. A hysterectomy is done by dividing the round ligaments, accessing the broad ligaments, dividing the uterine vessels and mobilising the uterus out of its peritoneal coverings by dividing the uterosacral ligaments. If the ovaries are to be left in position, the utero-ovarian ligaments are transected. The pelvic lymph nodes and sometimes the para-aortic lymph nodes are removed through 1 of the abdominal incisions or through the vagina. The upper vagina, cervix and uterus are removed through the vagina. The technique is distinct from laparoscopically assisted vaginal hysterectomy, which combines laparoscopic division of the infundibulopelvic ligaments and the uterine vessels, before a vaginal hysterectomy is done. A nerve-sparing radical hysterectomy is a modified technique that preserves pelvic nerves to prevent bladder dysfunction. The aim is to remove all the cancer. The suggested benefits of the laparoscopic approach are shorter length of stay in hospital, shorter recovery period and minimal abdominal scarring.

Provisional Schedule

Expected publication 18 March 2020

Timeline

Key events during the development of the guidance:

Date Update
24 October 2019 - 21 November 2019 Interventional procedure consultation

For further information on how we develop guidance, please see our page about NICE interventional procedures guidance