Robotic Surgery: An advanced treatment approach to treat Gynaecological Cancers

Cancer is a condition where the cells in the body grow out of control. When cancers develop in a woman’s reproductive organs, it is termed gynaecological cancer. The common type of cancer includes cervical, ovarian, uterine, vaginal, and vulvar.
Robotic surgery is the recent advancement in the field of minimally invasive surgery. It is used to perform surgeries for endometrial, Vulvar and some Ovarian cancer. The advantage of these procedure is it often causes less bleeding, minimal pain & discomfort and helps in quick recovery and return of normal bowel functions usually allowing patients to get back to their normal routine in a short span.

Types of Gynaecologic Cancer
Gynaecological cancers develop in different areas within a woman’s reproductive organs.
1.     Cervical Cancer: It sets in the cervix, which is the lower, narrow end of the uterus (neck of the womb).
2.     Ovarian Cancer: It begins in the ovaries, which are situated on each side of the uterus.
3.     Uterine Cancer: The uterus is the pear-shaped muscular bag that holds a baby when the woman is pregnant. Cancer starts in the lining of the uterus. It is also called uterine or endometrial cancer.
4.     Vaginal Cancer: It begins in the vagina, the hollow, tube-like channel between the end of the uterus and the outside of the body.
5.     Vulvar Cancer: It begins in the vulva, the outer region of the female genital organs.
Each type is distinct, with varied signs and symptoms, different risk factors and preventive measures. Generally, all women are at high risk of developing gynaecologic cancers and the risk elevates with age. However, when cancers are diagnosed at early stage, treatment is most effective.
Several modes of treatment are available for gynaecologic cancers, and it usually depends on the type of cancer and how far it has spread. Surgery, chemotherapy, and radiation are some of the treatment options. Women with gynaecologic cancer mostly undergo more than one type of treatment.
In recent years, robotic-assisted surgery has taken medical care to massive leap towards the better treatment outcomes. Robotic surgery for treating gynaecologic cancer has superseded laparoscopic surgeries due to various perks.
Robotic-Assisted Surgery
Robotic surgery is also known as robot-assisted surgery. This 3D imaging technology lets the surgeon perform complex procedures with more accuracy than conventional techniques.
Robotic-assisted surgery is a minimally invasive approach for effectively treating gynaecologic cancers, that often results in less bleeding, less scarring, less post-operative pain, and minimal risk of infection than most invasive options. These techniques may result in faster recovery and return of bowel function, thereby letting patients resume their work and regular activities more quickly.
 
How Robotic Surgery Works?
Robotic surgery is basically a laparoscopic procedure, during which the surgeon uses a thin tool with a light and tiny camera called a laparoscope via small incisions in the patient’s skin. The laparoscope sends detailed images back to a computer console so that surgeon can see inside without the need to make larger cuts.
 Robotic surgery lets the surgeon see the treatment area clearly in high-definition 3D and it also gives a better range of motion and rotates in a 360-degree motion. Robotics has remarkably changed the minimally invasive functionality and application in gynaecology oncology.
However, a small percentage of robotic-assisted surgeries may result in alternating from minimally invasive surgery to open surgery due to complications.
Gynaecological Cancers Treated With Robotic Surgery
Robotic surgery is used for most gynaecologic cancer treatments including:
•       Ovarian cancer
•       Uterine cancer
•       Endometrial cancer
•       Fallopian tube cancer
•       Cervical cancer
The key goals of surgeons when they perform gynaecologic cancer surgery include:
•       Combatting the patient's cancer in the best possible way
•       Making the patient's recovery as fast and efficient as possible
Who Can Go for Robotic Surgery?
Most woman with early-stage tumours will be potential candidates for robotic-assisted surgery. Some patients with very large ovarian tumours or advanced-stage disease that need a large incision to remove the tumours are not considered for robotic-assisted surgery. Also, obese patients need special consideration, and it is feasible only when the surgeon works with an anaesthesiologist to place the patient in a safe position without putting any pressure on the lungs and upper organs.
What To Expect Before a Robotic Surgery?
The surgeon will provide patients with specific instructions on how to prepare for the surgery.
Preoperative tests including blood tests, urinalysis, urine culture, chest x-ray, ECG, or other diagnostic tests are taken as needed.
Patients are advised to stop taking medications like aspirin, blood thinners, and/or anti-inflammatory medicines 10 days before surgery.
Patients should stop eating and drinking at least 8 hours before surgery. However, the patient is allowed to take vital medications with a sip of water on the morning of surgery.
Post Robotic Surgery
After the surgery, the patient is observed for a day or 2 in the hospital, until the patient attains certain clinical milestones. The course of recovery typically depends on several factors like the type of cancer and specific surgery. However, robotic surgery often shortens hospital stays and patient is expected to go home within 2 or 3 days.

Authored by:
Dr. Swati Shah, Surgical Oncologist, HCG Cancer Centre, Ahmedabad.