Traditionally, surgery for gynaecological cancers was carried out via a large incision in the abdomen. This procedure is called a laparotomy, and it is still used as an effective treatment today when it is deemed to be the most appropriate surgical approach for a patient.
However, advances in technology have made it possible to use minimal access surgical techniques, such as laparoscopic surgery and ground-breaking robotic surgery, in the treatment of certain gynaecological cancers.
In laparoscopic surgery, also known as keyhole surgery, a surgeon makes several small incisions and uses a tiny video camera to see inside the body. Robotic-assisted surgery is the latest innovation in minimal access surgery, offering a higher level of precision and quicker recovery times.
For robotic surgery, a surgeon uses robotically controlled arms to manipulate the surgical instruments. The surgeon sits at a console a short distance away from the patient to operate the robot’s arms.
At HCA Healthcare UK, we have the capability across our hospitals to provide the full range of treatment options for patients with gynaecological cancers, including both laparoscopic and robotic surgery.
Using cutting-edge technology
Miss Adeola Olaitan, Consultant Gynaecological Oncologist and Chair of HCA UK’s Gynaecology Cancer Board, regularly uses the state-of-the-art da Vinci Xi robotic surgical system at The Wellington Hospital to treat patients with gynaecological cancers.
"Robotic surgery is a progression of laparoscopic surgery,’ she explains. ‘The da Vinci Xi robot has the advantage of being more precise. You also get a very magnified view so you can almost see every single blood vessel.
Using the robot means you can run the surgery at lower gas pressures, which translates into a quicker recovery and less post-operative pain for the patient."
Deciding the most appropriate treatment for the patient
There are many factors that contribute to deciding the most appropriate treatment for an individual, and not all patients are suitable for minimal access surgery. At HCA UK’s hospitals, consultant surgeons have multidisciplinary team meetings with oncologists, radiologists and other healthcare professionals to discuss a patient’s individualised treatment plan.
"Gynaecological cancers very rarely have just one treatment: treatment could include surgery and radiotherapy or surgery and chemotherapy,’ says Miss Olaitan.‘Working as an integrated team improves care and patient experience."
The type of surgery used is always tailored to what is appropriate for the individual patient. "A laparotomy may be needed to remove a lesion that’s just too big to come out any other way, but most gynaecologists believe that minimal access techniques should be the default for lesions that can be removed through a small incision," she explains.
For endometrial cancer, which is cancer of the lining of the womb, minimal access surgery is often preferable to a laparotomy. "Endometrial cancer is associated with a high body mass index (BMI), and people with a high BMI may have other conditions, such as diabetes, which can lead to poor wound healing," says Miss Olaitan. "For a patient with endometrial cancer who has a high BMI, I would usually suggest the route of minimal access surgery."
"I also use minimal access surgery for a staging procedure. That’s where a patient has already had a cyst or an ovary removed and it turns out to be cancer unexpectedly. I use minimal access surgery to remove the other organs at risk, for example the other ovary, the lymph glands or the omentum."
For patients with late-stage ovarian cancer, a traditional laparotomy remains the typical surgical approach. That’s because ovarian cancer tends to spread, so more than one lesion needs to be removed, and the lesions are typically quite large. However, whether robotic-assisted surgery could be used for these patients is a focus of ongoing research.
"I think there is a possibility that robotic systems will be used in the future for ovarian cancer surgery," says Miss Olaitan. "Most people who have extensive ovarian cancer will need chemotherapy, and if they can have robotic surgery that allows them to heal very quickly, then they can start chemotherapy without delay."
"With the robot, the whole treatment pathway for ovarian cancer could be shortened and patients could go back to normal life quicker. This needs to be subjected to a bigger trial, but it’s potentially an exciting growth area for the use of the robot. It could really shift the needle in terms of what we do for women."
Find out more about Miss Adeola Olaitain and book an appointment