Gynaecological Cancer Treatment

We can use Lararoscopic (key hole) Surgery for the treatment of Uterine cancers, Cervical cancers and ovarian cancers. The use of laparoscopy for the diagnosis and treatment of gynecological cancers is well established. There were early concerns about the spread of disease and inadequate surgery, but these have been put to rest with new technologies, giving greater precision from the magnification afforded on the video screen, improvements in techniques and equipment.

The advantages of significantly less morbidity, early mobilisation and better recovery are incentives enough for both gynae onco-surgeons and patients to opt for this approach. An added advantage in cancer patients is the significant advantage of being able to start post-operative chemotherapy or radiotherapy earlier, often within a week of laparoscopy. This compares to waiting two to three weeks for a traditional abdominal surgery wound to heal.

Patients with cervical and endometrial cancers are treated using the laparoscopic approach. The surgery is for pelvic and para-aortic lymphadenectomy combined with either a laparoscopic or vaginal hysterectomy.

In the early days there were concerns that treatment of ovarian tumors by laparoscopy may occasionally result in inadvertent tumor spillage. This has been addressed during laparoscopy by removing all adnexal masses, even those unlikely to be malignant, in an endobag. This is the established gold standard of treatment.

When ovarian cancer is diagnosed during laparoscopy an immediate/early staging procedure becomes mandatory. This staging can be by laparotomy or laparoscopy depending on the surgeon‘s comfort level and expertise with the laparoscopic techniques.

For followup treatment of ovarian cancers, laparoscopy may be used for a procedure called a second-look operation, which may be aimed at cytoreductive surgery in advanced cancer. This reduces the amount of tumor present, to allow chemotherapy to work better. There is currently a debate as to whether laparoscopic or traditional laparotomy is better.

The treatment of late-stage disease by laparoscopy is currently being debated. The main issues revolve around efficiency in reducing morbidity verses maintenance of quality of life.

Before key hole surgery, we advise talking general precautions, such as fasting to keep the stomach empty and allow for a safer anesthetic. We also check to see that the general health of the patient is good enough to allow for safe surgery and recovery. Specific precautions include purging the bowels to empty them, making it easier to keep them out of harm’s way. If a clean and empty bowel is damaged during surgery, repair can be carried out. Healing is better than in an unprepared (loaded) bowel.