Robotic surgery has revolutionized the field of gynecological oncology by enabling surgeons to perform complex surgeries with precision and minimal invasiveness.

Robotics have become one of the most promising advancements in the medical field, as the technology allows surgeons to perform surgeries with minimal blood loss, less postoperative pain, and faster recovery time. This article examines some of the complex cases in robotic surgery for gynecological cancer.

Robotic surgery in gynecological oncology

Robotic surgery has been increasingly used in the gynecological oncology field over the past decade.

The use of robotic surgery is particularly beneficial for complex procedures, such as radical hysterectomy, lymph node dissection, and management of recurrent ovarian cancer.

Case 1: Stage IV ovarian cancer

A 55-year-old patient presented with a diagnosis of stage IV ovarian cancer, with multiple peritoneal metastases. Due to the extent of the disease, traditional open surgery was not an option as it would have resulted in significant morbidity.

The patient was scheduled for robotic surgery to remove all visible tumors in the peritoneal cavity, followed by chemotherapy.

The robotic surgery was performed with four arms, and a dual console was used to enable two surgeons to work simultaneously. The surgery involved resection of all identifiable tumors, followed by peritoneal washing.

During the procedure, the surgeon performed the removal of the omentum, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy, infracolic omentectomy, and resection of the metastatic implant on the liver and splenic capsule.

The patient was discharged on the fifth postoperative day and received chemotherapy for 6 cycles. After two years of surveillance, the patient remained disease-free.

Case 2: Cervical cancer with enlarged lymph nodes

A 40-year-old woman was diagnosed with cervical cancer. Imaging studies showed enlarged para-aortic lymph nodes. The patient was not suitable for traditional open surgery due to morbid obesity and history of asthma.

The patient was scheduled for robotic surgery.

The robotic surgery involved radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymphadenectomy. The lymph nodes identified on preoperative imaging were selectively removed.

The surgery was completed within four hours, and the blood loss was less than 50 ml.

The postoperative period was uneventful, and the patient was discharged on the fourth postoperative day. The pathology report confirmed stage IIB cervical cancer with negative surgical margins, and the removed lymph nodes were negative for metastasis.

Case 3: Recurrent endometrial cancer

A 65-year-old patient with a history of endometrial cancer was previously treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and ovarian suspension. A year later, she was diagnosed with recurrence of the endometrial cancer.

Due to the multiple areas of recurrence, open surgery was not recommended. The patient was referred for robotic surgery.

Robotic surgery was performed with five-arm ports and a dual console. The surgery involved removal of the uterus and cervix, bilateral salpingo-oophorectomy, and excision of the metastatic implants in the pelvic and para-aortic areas.

The patient was discharged on the fourth postoperative day, and the pathology report showed negative margins. Postoperative chemotherapy was started, and there was no evidence of disease on follow-up exams.

Case 4: Borderline ovarian tumor

A 35-year-old patient presented with a pelvic mass found during a routine exam. Imaging studies showed a 15 cm left ovarian mass, and a biopsy of the mass showed features of a borderline tumor. The patient was scheduled for robotic surgery.

The robotic surgery involved removal of the uterus and cervix, bilateral salpingo-oophorectomy, and complete excision of the ovarian tumor. The surgery was completed within three hours, and there was no significant blood loss.

The patient was discharged on the third postoperative day, and the pathology report confirmed a borderline tumor without evidence of invasion.

Case 5: Vaginal cancer

A 70-year-old patient presented with vaginal bleeding and was diagnosed with vaginal cancer. The patient was scheduled for a robotic surgery.

The robotic surgery involved removal of the uterus and cervix and complete excision of the vaginal tumor. There was no lymph node metastasis. The surgery was completed within four hours, with minimal blood loss.

The patient was discharged on the fourth postoperative day and received radiation therapy. The patient remained disease-free on follow-up.

Risks associated with robotic surgery for gynecological cancer

Robotic surgery for gynecological cancer is generally safe, but complications can occur. These complications may include infection, hemorrhage, thromboembolism, and damage to adjacent organs.

There are fewer complications associated with robotic surgery compared to open surgery, but careful patient selection and preoperative preparation are important steps to minimize risks associated with robotic surgery.

Conclusion

Robotic surgery has revolutionized the field of gynecological oncology, allowing clinicians to perform complex surgeries with precision and minimal invasiveness.

While there are risks associated with robotic surgery, careful patient selection, preoperative planning, and proper training for surgeons can help minimize these risks.