Advancing Minimally Invasive Surgery for Gynecologic Oncology
February 14, 2022
Innovations in Obstetrics & Gynecology | Winter 2022
Robotic surgery for gynecologic cancer cases was approved by the FDA in 2005, making it a relatively new approach to gynecologic oncology. Surgeons at University Hospitals in Cleveland regularly perform robotics-assisted procedures, and they are looking for ways to innovate and drive the field of minimally invasive surgery in gynecologic oncology forward.
Gynecologic oncologists at University Hospitals Cleveland Medical Center and across the country perform minimally invasive procedures to treat uterine cancers, vulvar cancers, endometrial cancers and cervical cancers. These minimally invasive procedures can be done via laparoscopy or robotics.
The minimally invasive approach allows surgeons to perform procedures that result in less pain and faster recovery times for patients.
Sentinel lymph node mapping
As minimally invasive surgery has become a mainstay of gynecologic oncology care, more techniques have emerged. For example, sentinel lymph node mapping has made it easier to evaluate lymph nodes for cancer.
“Sentinel lymph node mapping was originally established in other cancer types, such as breast cancer, melanoma and penile cancers, and it has become more frequently studied, used and validated in vulvar cancers and cervical cancer, as well as more recently in endometrial cancers,” says Anna Strohl, MD, co-chair of the University Hospitals Robotics Committee. “It is a less-invasive technique that allows us to get information about lymph node status without having to expose patients to more morbidity.”
Before the sentinel lymph node technique was developed, all lymph nodes in a lymph node basin had to be sampled in a patient with cancer that could spread. Sentinel lymph node mapping makes use of dyes that allow surgeons to identify the one or two lymph nodes that may need to be removed.
New types of dye are being developed to further enhance sentinel lymph node mapping. For example, surgeons may be able to use these newer dyes in concert with handheld technology to perform the mapping procedure, even during traditional open surgery.
Innovation at UH
Dr. Strohl is involved in expanding the robotics program at University Hospitals. She is part of the UH Robotics Committee, which is working to bring a third robotics system to UH to increase patient and provider access.
“We’re also looking into developing a surgical coaching program, in which surgeons who are new to the robotic platform can partner with more established robotic surgeons and review cases, review techniques and become both more efficient, as well as push their own limits in terms of which cases they can do minimally invasively with the robotics platform,” she says.
University Hospitals in Cleveland is looking to develop more access to robotic surgery, not only for gynecologic oncology but also for benign gynecology cases and cases performed in other surgical divisions.
Minimally invasive surgery performed at UH is paired with the Enhanced Recovery After Surgery program, which focuses on the patient experience before, during and after surgery. The ultimate goal is to reduce patient pain, reduce recovery time and improve outcomes.
Experts at UH are also looking for ways to expand the indications for minimally invasive procedures in gynecologic oncology. “In addition to the day-to-day clinical work, we are interested in clinical trials and research, really trying to advance the field,” Dr. Strohl says.
UH has been selected as a site for an international randomized controlled trial examining surgical and oncologic outcomes for robotic-assisted radical hysterectomies, versus traditional, open radical hysterectomies in patients diagnosed with cervical cancer. “[We are also] hoping to expand the techniques that we’ve really honed and developed for endometrial cancers and cervical cancers and bring those to [some selected cases of] ovarian cancer,” Dr. Strohl says.
UH is working to make minimally invasive surgery the gold standard of care in gynecologic oncology, as well as in other specialties, she says. “The flexibility and the willingness to innovate and to be open to new ideas has allowed us to develop the minimally invasive programs that we have here.”