Minimally invasive surgery has become the standard of care for many gynecologic malignancies, especially in the management of uterine cancer. If appropriate, the staging of early uterine cancer is performed robotically through three to five small incisions. This approach allows the patient to experience less pain, bleeding and complications compared with a conventional, open procedure. Sentinel node biopsy, the removal of only a few nodes instead of many, via the robotic approach has been shown to be more accurate and comes with less blood loss, less pain and less post-operative changes. Both procedures are now considered outpatient, with most patients able to return home within hours of the procedure.
For early cervical cancer, robotic radical hysterectomy, removal of the cervix and tissue around the cervix with the uterus, and removal of lymph nodes provides similar advantages. In selected cases a fertility sparing procedure – a robotic radical tracheolectomy with lymphadenectomy – can be performed where the cervix and surrounding tissue is removed with removal of the pelvic lymph nodes.
In addition, early ovarian cancer can successfully be staged through a robotic approach with pelvic and periaortic removal of lymph nodes, as well as omentectomy (removal of the fatty apron of the stomach) with or without hysterectomy in a fertility-sparing approach.
Gynecologic oncologists are often called upon to perform complex non-cancerous gynecologic procedures, given our training as expert pelvic surgeons. These include robotic procedures for the treatment of endometriosis where scarring of the pelvic tissues is often found. In addition, many larger ovarian masses can be removed in an “extracorporeal” approach. This allows the mass to be placed in a bag, where it can be separated into smaller pieces for removal through a smaller incision and allowing faster recovery. In addition, High-risk genetic screening and testing can be done and risk reducing surgery, offered through a robotic approach, can be performed for patients who have inherited a gene that increases the risk of cancer to the female organs.
Our team consists of gynecologic oncologists, an advanced practice nurse, a physician assistant, a clinical care coordinator, and a patient navigator. All cancers are presented at our multidisciplinary bimonthly tumor board, where treatment plans are formulated based on the most recent scientific evidence. Eligible patients are screened for available clinical trials.
Gynecologic oncologists are unique in the surgical world. Not only do we perform complex surgery, but we also administer chemotherapy, providing an inclusive patient experience. We integrate palliative care and addiction medicine in our practice to meet the wide spectrum of additional patient concerns.
- Bernadette M. Cracchiolo, MD, MPH