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Management of endometrial cancer with the Da Vinci Robot

Tuesday 6 March 2018

Endometrial cancer is the commonest gynaecological malignancy with lifestyle issues, such as obesity, resulting in an increasing incidence of the cancer.

This malignancy is generally managed with a hysterectomy, bilateral salpingo-oopherectomy and staging operation.

Depending on stage and grade of the tumour adjuvant therapy is offered, usually in the form of radiotherapy or chemo-radiation.

Staging usually involves a pelvic and sometimes a para-aortic lymphadenectomy. Unfortunately, in 15 to 20 per cent of cases a lymphadenectomy can result in some degree of lymphoedema.

Lymphoedema cannot be cured and can be extremely difficult to manage with a detrimental effect on patient quality of life.

As a result we are aiming to manage these patients with sentinel node biopsies, rather than an extensive pelvic lymphadenectomy. This procedure allows for assessment of nodal status and thereby guides adjuvant treatment, without the risks of lymphoedema.

The procedure involves an injection of Indocyanine green (ICG), a fluorescent dye, into to cervix, and with the aid of a fluorescence camera the sentinel nodes can be identified.

This can be performed laparoscopically using a specific florescence laparoscope, or robotically.

The Da Vince Xi robot recently acquired by Mater Private Hospital Brisbane has an incorporated florescence camera, to allow routine identification of sentinel nodes. Below is an image of a sentinel node during a robotic procedure.

Gynaecological oncologists Lewis Perrin, Naven Chetty and Nisha Jagasia at Mater Private Hospital Brisbane are now robotically trained and are happy to consider patients for this and other robotic procedures.

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Article written by Dr Naven Chetty.

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