Robotic surgery for gynecologic cancers

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was reviewed on May 18, 2022.

Robotic-assisted surgery, which offers a minimally invasive approach to treating gynecologic cancers, often causes less bleeding, less scarring, less post-operative pain and discomfort, and a lower risk of infection than more invasive options. These procedures may also lead to a quicker recovery and return of bowel function, potentially allowing patients to return to work and their normal daily routine more quickly.

All City of Hope locations use the da Vinci® Surgical System for robotic surgery procedures on gynecologic cancers.

Cancer Treatment Centers of America® (CTCA) is now City of Hope®, joining forces to expand patient access to personalized, comprehensive cancer care.

How robotic surgery works

In traditional open surgery, the surgeon makes a long incision to access the area for treatment. In minimally invasive procedures such as a laparoscopy or robotic surgery, the surgeon relies on a scope and instruments that are manipulated through a few small incisions, with the treatment area visible through the use of tiny cameras.

Compared with laparoscopy, robotic surgery allows the surgeon to see the treatment area better—in high-definition 3D. The technology also gives the surgeon better range of motion because the small instruments follow the movement of the surgeon’s wrists and can rotate in a 360-degree motion. By comparison, laparoscopic tools are maneuvered by the surgeon’s hands, while the surgeon manipulates robotic tools remotely while sitting at a console.

“Robotics has changed the minimally invasive functionality and utilization in gynecologic oncology and the general gynecologic surgery world,” says Ruchi Garg, MD, National Program Director for Gynecologic Oncology at City of Hope Atlanta, Chicago and Phoenix. “I do 90 percent of surgeries robotically.”

A small percentage of robotic-assisted surgeries and laparoscopies may result in switching from minimally invasive surgery to open surgery due to complications or feasibility. Patients should discuss any concerns they have with their gynecologic oncologist.

Robotic surgery treatments for gynecologic cancers

Robotic surgery at City of Hope is available for most gynecologic oncology procedures, including:

  • Hysterectomy, or the removal of the uterus with the cervix
  • Omentectomy, or the removal of the omentum, which is a fatty layer of tissue connecting the abdomen to other organs
  • Oophorectomy, or the removal of the ovaries
  • Salpingectomy, or the removal of one or both fallopian tubes
  • Bilateral salpingo-oophorectomy (BSO), or the removal of both ovaries and both fallopian tubes
  • Radical hysterectomy, or the removal of uterus, cervix, surrounding parametria and part of the vagina (and possibly, ovaries and fallopian tubes, too)
  • Biopsy, or the removal of tissue samples to determine the cancer’s stage
  • Debulking, or the removal of as much of a tumor as is possible
  • Lymphadenectomy, or the removal of lymph node(s), including sentinel lymph nodes
  • Pelvic exenteration, or the removal of reproductive organs (ovaries, fallopian tubes, uterus, cervix and upper vagina), the bladder and/or rectum, lymph nodes in the pelvis, and possibly parts of the anus or colon

Gynecologic cancers treated with robotic surgery

Robotic surgery is available for most gynecologic cancer treatments. The types of cancer treated with robotic surgery include:

Robotic surgery had been used more extensively in the past for cervical cancer, but a 2018 study found that a radical hysterectomy performed through traditional open surgery yielded better outcomes for early-stage cervical cancer than procedures using robotics or laparoscopy. The study found that the minimally invasive approaches produced a higher cancer recurrence rate and worse overall survival for patients. A new trial, offered to qualified City of Hope patients, is underway to further investigate those results.

Robotic surgery may be used for cervical cancer, either as part of the new study or in cases where the patient has been counseled extensively about the concerns the earlier study raised.

The role sentinel lymph nodes play

Robotic surgery may also be used as a less-invasive tool to determine whether a gynecologic cancer has spread. Using fluorescence imaging during surgery, the surgeon identifies the sentinel lymph nodes (or the first lymph nodes the cancer would spread to if it has metastasized). The surgeon then removes those nodes for biopsy to see whether cancer has spread.

“If we didn’t do that, we’d have to remove the whole section of lymph nodes, and that ends up being about seven to 14 lymph nodes,” Dr. Garg says. This procedure may be performed as part of another surgery, adding only a short amount of time to the operation

Who’s a candidate for robotic surgery?

Not everyone is a candidate for robotic gynecologic surgery. For example, patients who have a larger cancer mass would not be recommended for the procedure, because the surgeon needs to be able to place the cancerous tissue into a surgical bag, limiting the tumor’s size to the size of the bag. Breaking the tissue into pieces isn’t an option, because that may cause the cancer to spread inside the abdomen.

Obese patients require special consideration because patients are put in the Trendelenburg position, where the body is tilted with the head in a downward position, which puts pressure on the lungs and upper organs. The surgery is feasible and usually has positive outcomes when the surgeon works with the anesthesiologist to put the patient in a safe position, as we do at City of Hope.

Managing side effects of robotic surgery

The smaller incisions used in robotic surgery may lead to less pain or bleeding than side effects caused by traditional surgery, but experiences vary from patient to patient. That’s why, at City of Hope, we offer a wide range of supportive care services to help manage the side effects of cancer and its treatments, before, during and after your procedure.

Potential side effects of robotic surgery include:

  • Pain
  • Nausea
  • Bleeding
  • Loss of appetite
  • Fatigue
  • Sexual side effects
  • Infection

Your City of Hope care team will work with you to help you manage and, when possible, prevent robotic surgery-related side effects so you can maintain your quality of life. Services include:

Pain management: A pain management physician may prescribe narcotic and/or non-prescription therapies to help ease discomfort so you can get back to your daily activities.

Behavioral health: One-on-one, couples and group counseling, as well as sexual health counseling, are available to all patients and their caregivers.

Oncology rehabilitation: Occupational therapists may help restore your mobility, while our oncology-trained physical therapists are available to evaluate and treat pelvic floor dysfunction.

Nutritional support: A dietary plan may help with digestive issues while supporting mood and energy.

Spiritual support: Chaplains are available to conduct spiritual counseling.

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