Robotic Staging Surgery for Endometrial Cancer

Specialist:
Yi-Jen Chen

Overview

Endometrial cancer is the most common female genital cancer in developing countries. It is commonly found in postmenopausal women and is often diagnosed through transvaginal ultrasound or endometrial biopsy. The standard treatment for endometrial cancer involves surgery, followed by chemotherapy and/or radiation therapy. The robotic technique is a suitable option for endometrial cancer treatment, and in comparison to traditional laparoscopy and laparotomy, it is associated with reduced operative morbidity and shorter hospital stays.

Features

The purpose of staging surgery is to treat and stage endometrial cancer. By using indocyanine green and near-infra-red fluorescent imaging (Firefly®) in real-time sentinel lymph node biopsy and dissection, robotic surgery is a more sensitive and accurate technique for nodal assessment. The benefits of robotic surgery include less blood loss, lower risk of lymphedema and complications, and shorter postoperative hospital stays.

Procedure

The pelvic lymphadenectomy is performed prior to the hysterectomy, and aortic node sampling is performed after the hysterectomy. The process starts with injecting a fluorescence dye into the cervix. The retroperitoneal space is opened, and the anatomy is identified under the scope. The lymphadenectomy is performed, including the distal common iliac nodes, nodes surrounding the external iliac artery and vein, and obturator lymph nodes. The para-aortic lymph nodes are sampled later. The fluorescence dye helps to identify the lymph nodes more precisely, collected in a tissue bag. The hysterectomy and bilateral salpingo-oophrectomy are performed, and the specimen are removed through the vagina. The vaginal cuff and surgical wound are closed.

Notification

Risks and Complications

• Intraoperative complications such as vessel injury, bladder/ureter injury, and bowel injury
• Leg pain/edema
• Vaginal vault bleeding, infection, and leakage
• Infections such as wound infection, urinary tract infection, pelvic abscess, and peritonitis
• Chyle ascites
• Hematoma
• Severe muscle strain