Gynaec Cancer surgery – Personalised therapy from Minimal to Maximal approach,Open, Laparoscopic, Robotic,HIPEC, PIPEC

Gynaecologic Oncology is a subspecialty of Obstetrics and Gynecology that focuses on diagnosing and treating women with cancers of the reproductive system.

It focuses on cancers of the female reproductive system, including ovarian cancer, uterine cancer, vaginal cancer,cervical cancer, and vulvar cancer.

The multi-disciplinary team is made up of gynaecological cancer surgeons, oncologists (specialists in radiotherapy and chemotherapy), psychologists, clinical nurse specialists, physiotherapists to provide comprehensive care for women with pre-malignant and malignant gynaecological conditions

Treatment of the following diseases:

• Premalignant Diseases of Vulva and Vagina

• Premalignant Diseases of Cervix

• Cervical Cancer

• Endometrial Cancer

• Ovarian Cancer

• Vulval Cancer

• Vaginal Cancer

• Cancer of Fallopian Tube

• Gestational Trophoblsatic Neoplasia

Services provided

• Screening for Cervical Cancer: Pap Smear/Liquid based cytology/ HPV testing

• Colposcopy Clinic

• Excision Procedures for Premalignant Lesions of Cervix: (Loop Electrosurgical Excision/ Cone Biopsy)

• Evaluation/consultation and Counselling for high-risk individuals due to strong family history of Ovarian/Breast Cancers

• Surgical procedures for diagnosed cases of Gynecological Cancers –

• Surgery for early Ovarian Cancer (Staging Laparotomy)

• Surgery for advanced Ovarian Cancer (Debulking Surgery)

• Radical Hysterectomy (Wertheim’s Operation )

• Surgery for Endometrial Cancer

• Total Pelvic Exentration

• Anterior/Posterior Pelvic Exentration

• Pelvic/Paraortic (Retroperitoneal) Lymph Node Dissection

• Radical Vulvectomy + Groin Node Dissection

• Radical Vulvectomy + Reconstruction

Robotic Surgeries:

Gynecological Cancer Surgeries were performed by two approaches: Conventional Open Surgery and Laparoscopic (Key Hole Surgery).

Robotic Surgery is a perfect combination of both Conventional Open Surgery and Laparoscopic Surgery. The surgery is performed through keyhole just like laparoscopic surgery, but the instrumentation and the vision is totally different. The Robotic Surgery instruments are Wristed, which means they have a similar flexibility like human wrist as against laparoscopic surgical instruments where the movements of instruments are restricted. The vision for the surgeon is Three Dimensional (3D), while in conventional laparoscopic surgery it is two dimensional 2D. Three-Dimensional vision is just like what you see in Open Surgery; hence the surgical precision is more with less trauma. This combination of wristed instruments, three dimensional vision, 12 times magnification, makes it a safer alternative to conventional laparoscopy. Also, it makes performance of complex surgeries much easier.

Robotic Assisted Surgery can be used to perform:

• Endometrial Cancer Surgery (Cancer of Body of Uterus)

• Cancer Cervix: Radical Hysterectomy

• Pelvic Exenteration

• Radical Trachelectomy

• Restaging Surgery for Endometrial/Ovarian carcinomas.

We have started robotic surgery for Gynaec cancers a decade ago. The tremor filtration helps in holding instruments steady especially over vessels like aorta, iliac vessels, the 7 degree movement and endo wrist of robotic instruments help in deeper dissections in pelvis like in parametrial dissection, nerve preservation and nodal dissection. The magnification and 3 D vision of robotic camera helps in visualisation of small vessels, controlling them better, better nerve visualisation and preservation.We found better nodal yield in our robotic procedures.These help in faster discharge and faster return to work.

At the same time our team is trained in HIPEC,hyperthermia intraperitoneal chemotherapy after cytoreductive surgery. I went to Sheeba Chayne Caner Institute in Israel for HIPEC training under Dr. Avram Nissan. It is a great institute with excellent work and learnt a lot about HIPEC.

My biggest experience there was visitingJerusalem. I didn’t realise its importance till I walked along the streets Lord Jesus had been there. It was mid blowing to see all those streets and visit the holiest of the holy places and I gained spiritually. I can never forget Jerusalem in my life.

PIPEC is another newer modality of treatment available for advanced peritoneal disease like in ovarian cancer . I went to Seoul National University, Korea to get trained and certified in this procedure.

I realised after doing all these advanced modalities of treatment procedures for Gynaec cancers that every patient is different, every cancer is different. We need to have judgement to individualise each case and use appropriate modality for the cancer. And always be honest with patient and explain the procedure, the cure rates and complications because each patient has a family and own world she wants to live on. And respect to her choice and wishes is very important in decision making.