Robotic staging surgery

Overview

Endometrial cancer is the most common female genital cancer in the developing world, with adenocarcinoma of the endometrium the most common type.

Approximately 75% of women with endometrial cancer are postmenopausal, and the most common symptom is abnormal vaginal bleeding. We could perform transvaginal ultrasound to estimate the thickness of endometrium, and endometrial biopsy for diagnosis. Standard management of endometrial cancer at diagnosis involves surgery, followed by chemotherapy with or without radiation therapy. For early stage primary endometrioid adenocarcinoma of the endometrium, laparoscopy and laparotomy are associated with similar rates of disease-free and overall survival and that laparoscopy is associated with reduced operative morbidity and shorter hospital stays. Robotic technique is also suitable for endometrial cancer treatment.

 

Features

The goal of staging surgery is to treat and stage endometrial cancer. Compare with traditional laparoscopy and laparotomy surgery, robotic surgery showed less blood loss, length of postoperative hospitalization, and complications.

 

Procedure

We perform the pelvic lymphadenectomy prior to the hysterectomy and the aortic node sampling after the hysterectomy. First, we injected fluorescence dye into cervix. Under the scopy, we open retroperitoneal space and identify anatomy. Later, lymphadenectomy is done, including distal common iliac nodes, the nodes surrounding the external iliac artery and vein and the obturator lymph nodes. Paraaortic lymph node is sampling later. Fluorescence dye make us identify lymph node more precisely. These lymph nodes are collected to tissue bag. Then, hysterectomy and bilateral salpingo-oophrectomy is performed. The specimen is removed from vagina, and we close vaginal cuff and surgical wound.

 

Notification

Risks & complication

  • Intraoperative complication: vessel injury, bladder/ ureter injury, bowel injury
  • Leg pain/ edema
  • Vaginal vault bleeding, infection, leakage
  • Infection: wound, urinary tract infection, pelvic abscess, peritonitis
  • Chyle ascites
  • Hematoma
  • Severe muscle strain

 

Estimated Cost

The procedure cost is about 700,000-750,000 NTD, prices are subject to change without prior notice; need to pay in accordance with the actual medical expenses.