Minimally Invasive Surgery Increasingly Used in Gynecologic Malignancies

Shana Wingo, MD

Robotic technology has facilitated the application of minimally invasive surgery for complex operations in gynecologic cancers. In many oncology practices, robotic surgery is rapidly taking the place of laparoscopy.

“The majority have adopted robotic surgery and minimally invasive technology in uterine malignancies, cervical cancer, and some early-stage ovarian cancers, where a surgeon is doing more of a staging procedure and not a tumor debulking,” Shana Wingo, MD, said during the 2017 OncLive^® State of the Science Summit on Ovarian Cancer.

According to Wingo, minimally invasive robotic surgery is comparable to laparoscopy and has been shown to have better recovery rates for patients. As the technology continues to improve, only a single incision is needed to conduct the surgery, as opposed to the typical multiport surgery.

“Some institutions are exploring the utility of a single site. The technique is a slightly bigger incision, but all the instruments come into 1 area, meaning you do not have multiple incisions,” explained Wingo.

OncLive: What surgical advances are you excited about across gynecologic malignancies?

In an interview with OncLive during the meeting, Wingo, a gynecologic oncology surgeon at Arizona Oncology, discussed advancements being made in the field of surgery for patients with gynecologic cancers.Wingo: More oncologists are doing minimally invasive surgery. In ovarian cancer, it's more difficult to adapt a minimally invasive approach as this is known to be a bulkier malignancy. The majority have adopted robotic surgery and minimally invasive technology in uterine malignancies, cervical cancer, and some early-stage ovarian cancers, where a surgeon is doing more of a staging procedure and not a tumor debulking.

In some institutions, where surgeons have more experience with robotic surgeries, there are more aggressive procedures being done. An exciting development is the technology for minimally invasive surgery continues to increase in quality. Typically, what is done is a multiport surgery when a physician is doing laparotomy robotics. Some institutions are exploring the utility of a single site. The technique is a slightly bigger incision, but all the instruments come into 1 area, meaning you do not have multiple incisions.

What do you find to be exciting about this technology?

Time will tell if these methods get adopted, but in endometrial cancer it's been studied to have better recovery for the patients. It is hard to know what innovators will do. Every time we think we have reached our maximum potential, some intelligent engineer develops new technology that takes it a step further.

Do you have any advice for physicians communicating these surgical procedures with their patients?

One of the important techniques that’s used is sentinel lymph node detection. When you do robotic surgery and laparoscopic surgery, you can inject dye into the cervix and identify the first lymph node that's draining a specific area, such as the cervix or uterus. There is also infrared detection technology determining where the lymph nodes are. I think the engineers do a phenomenal job of improving upon technology that we never would have imagined existed. The piece of advice that I have for physicians is to discuss the medicine and procedures in a way that patients will understand. In medicine, the terminology and the nomenclature that we use is complicated and especially when you're using these fancy terms, you can get lost in your medical background when you talk to patients. Being simple, using diagrams, helping people understand, are all important because it is profoundly amazing how people do not understand the anatomy of their body. When you’re a medical professional, you can understand things at a level 100, where as you might have a patient who’s at a level 1. Bringing it down to the level where someone can understand it is something that can be beneficial for any medical professional.

It takes time and effort to make sure patients understand. It's difficult because as doctors see more patients, they are trying to maximize efficiency but it’s important to remember to take a step back and explain to patients what you’re doing and why.