Gynecological Cancer Surgery

Gynecological Cancer Surgery

Till a few decades ago, the presence of cancer was considered as a contraindication to endoscopic surgery. However, with rapid advances in instrumentation and recognition of the multiple benefits of endoscopy, endoscopic surgery has become an acceptable modality of treatment for select cancers.

The two gynecological cancers ideally suited for endoscopic treatment are endometrial and cervical cancer.

Endometrial Cancer : Endometrial cancer is cancer of the lining of the uterus. The treatment of early stage endometrial cancer is a simple hysterectomy and, in select cases, pelvic lymphadenectomy (specialized organs which drain tissue fluid). Laparoscopic surgery is the route of choice for treatment of endometrial cancer.

Cervical Cancer : Cervical cancer is cancer of the mouth of the uterus. Early stage tumors are treated with surgery usually followed by radiotherapy. The surgery involves removal of the uterus with cervix & upper part of the vagina, removal of the surrounding supporting tissue (parametrium) and pelvic lymphadenectomy. Smaller tumors are ideal candidates for laparoscopic surgery. The larger tumors because of their vascularity (increased blood supply) may be difficult to manage by laparoscopy. However, treatment should be individualized.

Advantages of laparoscopy in gynecological cancers:
  1. Magnified view of pelvis with better illumination and better visualization of deeper structure.
  2. Gas under pressure in the abdomen opens up the natural tissue planes and makes dissection easier.
  3. Due to magnification, small vessels and lymphatic tissue can be tackled with greater precision
  4. Endometrial cancer patients usually are obese and diabetic. Laparotomy (open surgery) is associated with increased morbidity and risk of complications (deep vein thrombosis and wound infection). This is avoided with laparoscopy.
  5. Less morbidity & pain and superior cosmesis with laparoscopy.