Endometrial Cancer Surgery
Similar to what has been described in the medical literature for ovarian cancer, surgery for endometrial cancer is best performed by a Gynecologic Oncologist. Because the spread patterns for endometrial cancer can be subtle and may bypass nearby lymph nodes and skip to upper level lymph nodes, surgical staging of this disease by experienced and specialized cancer surgeons becomes very important. Moreover, because many women with endometrial cancer are obese and/or elderly with significant medical problems, the coordination of care before, during, and after surgery in the postoperative period is best managed by those with the highest levels of training.
Robotic Surgery for Endometrial Cancer
The majority of women with endometrial cancer can safely undergo a robotic-assisted total laparoscopic hysterectomy with bilateral salpingoophorectomy and lymph node dissection. Robotic surgery is similar to laparoscopic surgery in that it is a form of minimally invasive surgery. Robotic surgery is superior to laparoscopic surgery when a surgeon has to remove more than just one or two ovaries. For this reason, robotic surgery using the DaVinci robot is emerging as the new standard of care for the surgical treatment of endometrial cancer, because this disease requires the removal of not only the ovaries but also the uterus, the cervix, and oftentimes, nearby and far away lymph nodes. Robotic surgery has been shown to be a safer operation for these procedures primarily due to the 3-D visualization and articulating instruments that accurately mimic a surgeon’s normal hand movements. In this operation, the entire uterus and cervix along with the fallopian tubes and ovaries are removed as one specimen through an opening made at the top of the vagina. Depending on the pathologist’s immediate evaluation of this specimen (the so-called, “frozen section”), the surgeon will decide whether the pelvic and/or para-aortic lymph nodes need to be dissected. These lymph nodes along with a pelvic washing are removed through one of the small abdominal incisions and sent to the pathologist for careful examination. With robotic surgery, many patients can be discharged to their home on the same day as surgery, although it is not uncommon to monitor patients for one night in the hospital. Patients can start eating and walking several hours following surgery and by the fifth day most patients are driving. Two weeks following robotic surgery patients may return to work full time. The vagina is not shortened with robotic surgery and patients may expect normal sexual function following a six week period of pelvic rest.