Robotic-Assisted Fertility-Sparing Surgery for Early Ovarian Cancer

Abstract

Objective:To show the feasibility and safety of robotic-assisted laparoscopic fertility-sparing surgery for early-stage ovarian cancer in women of reproductive age.Methods and Design:The first patient was a 29-year-old para 0 woman with well-differentiated endometrioid adenocarcinoma of the ovary and complex endometrial hyperplasia with marked atypia. The second patient was a 31-year-old para 0 woman with an immature grade 1 teratoma. Both patients underwent robotic-assisted laparoscopic surgical staging.Results:In the first patient, there were no intra- or postoperative complications. Operative time was 5 hours 43 minutes and estimated blood loss was 100 mL. She was discharged home on postoperative day 1. She received 3 cycles of carboplatin and paclitaxel, as well as medroxyprogesterone acetate for the duration of chemotherapy. She conceived twice spontaneously since surgery and had two successful deliveries. She currently has no evidence of disease.In the second patient, there were no intra- or postoperative complications. Operative time was 2 hours 52 minutes and estimated blood loss was 200 mL. She was discharged home on postoperative day 1. She declined adjuvant chemotherapy with bleomycin, etoposide, and cisplatin. She conceived spontaneously 4 months later and had a normal vaginal delivery. She currently has no evidence of disease.Conclusions:Because fertility-sparing surgery is now accepted as a viable option in young women with early-stage ovarian cancer, less invasive techniques are being used. With the advent of robotic-assisted surgery and its advantages over conventional laparoscopy, we show that it is a safe and feasible approach in select patients. This is the first reported series on robotic fertility-sparing surgery, but more research is needed.

Robotic surgery for ovarian cancers: individualization of the surgical approach to select ovarian cancer patients

“…However, there are no comparative studies of laparoscopy vs laparotomy to confer the inferred benefits of laparoscopy . Hitherto, there has been only one report, describing two ovarian cancer patients, on robotic fertility‐preserving surgery .…”

A hybrid technique of combined conventional and robotic-assisted laparoscopy for staging and debulking of early, advanced, and recurrent ovarian, fallopian tube, and primary peritoneal cancer

“…Three patients in this group underwent fertility sparing surgery (Table 1; cases 6, 8, and 9) [14]. In the first case listed (Table 1), the para-aortic lymphadenectomy was performed laparoscopically as there was difficulty with adequate visualization when the robotic apparatus was docked.…”

“…Case 6 presented for restaging, after prior left salpingo-oophorectomy and staging. Among the 11 cases operated for advanced and/or recurrent ovarian cancer, the mean age was 63.9 years (range, 39-92), average BMI was 29.7 kg/m 2 (range, 22.1-37.2), EBL was 129.1 ml (range, 20-400), operating room time was 238 min (range, 103-477), and LOS was 3.8 days (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. In this group, surgical procedures consisted of six hysterectomies, five oophorectomies, eight omentectomies, three pelvic lymph node dissections (average, 10.7; range, 4-18), three para-aortic lymph node dissections (average, 5; range, 1-9), four appendectomies, five diaphragmatic biopsies, four upper abdominal debulking or diaphragmatic debulking, and one resection of a porta hepatis mass (Table 2; case 10; Fig.…”

“…Once malignancy is diagnosed, comprehensive surgical staging can be performed laparoscopically, which has been shown to be feasible, safe, and accurate in tumors of low malignant potential and invasive early-stage disease [16][17][18][19]. Furthermore, in select cases of localized disease, it can be used to perform fertility-sparing surgical staging [14].…”

Robotic Surgery in Gynecology

“…erken evre, seçilmiş olgularda konu tartışmalı olmakla birlikte bildirilmiş bir kaç seri mevcuttur. Bu olgularda minimal kan kaybı ve kısa hastanede kalış süresi gibi diğer çalışmalarda bildirilen olumlu sonuçlara benzer bulgular saptanmıştır (42,43). ancak sağ kalımla ilgili veriler operatif sonuçlar kadar yüz güldürücü değildir.…”