UF Health Uses Latest Robot for Minimally Invasive Surgery in Ovarian Cancer
For patients with ovarian cancer, the standard surgical approach is an open procedure, with the two alternatives being conventional or robotically assisted laparoscopy. Either form of minimally invasive surgery is suitable for carefully selected patients with early-stage ovarian cancer and those with Stage III or IV disease who have a good response to neoadjuvant chemotherapy.
“In North Florida, we have a lot of very elderly patients,” notes Joel Cardenas-Goicoechea, MD, an assistant professor in the UF department of obstetrics and gynecology. “Many of them are inclined to say they are too old for surgery and go into hospice care. Robotic surgery represents an opportunity for some patients who respond to neoadjuvant chemotherapy. The benefits include less bleeding, less pain, faster recovery and reduced risk of complications in properly selected patients.”
Cardenas and other gynecologic surgeons at UF Health have extensive experience with the da Vinci robot, and now they have acquired the latest model, the da Vinci XI. Some improvements include thinner robotic arms and instruments, as well as versatile, 3D views with higher resolution, setup automation and guidance. In addition, multiquadrant surgery can be performed without extensive repositioning. For gynecologic surgery, “the biggest advantage is the ability to rotate from the pelvic approach to the abdominal approach,” Cardenas says. “Before, that was a nightmare; it involved difficult maneuvers. But all that is history now and we are more efficient.”
The chance that conversion to an open procedure will be needed is much lower than with robotic surgery than with conventional laparoscopy, and robotic surgery is better for obese patients.
The National Comprehensive Cancer Network guidelines acknowledge the role of minimally invasive surgery for patients with ovarian cancer. Recent nonrandomized retrospective studies from Europe, Canada and the U.S. suggest that minimally invasive surgery is feasible and has oncologic outcomes similar to those of standard laparotomy. However, such a procedure must be performed only in centers with highly skilled gynecologic oncologists. Complete resection of ovarian cancer is the ultimate goal and an independent prognostic factor for survival.