Gynecologic oncologist Mario Leitao is one of several Memorial Sloan Kettering surgeons with expertise in minimally invasive surgery for uterine cancer.
At Memorial Sloan Kettering, our doctors usually begin the treatment of endometrial cancer with surgery, which for many women simultaneously provides removal of the cancer as well as diagnosis and staging information. In many cases, all of these steps can be completed over the course of a single surgical procedure.
Surgery alone may be curative if the cancer is contained completely within the uterus. In most cases we only recommend other therapies, such as chemotherapy, hormone therapy, or radiation therapy, if the cancer has spread into the deep uterine muscle layer or beyond.
At Memorial Sloan Kettering, a multidisciplinary team of uterine cancer experts discusses each case and takes into consideration such factors as the specific type and stage of the endometrial cancer before making recommendations on how to manage patients’ condition following surgery. We also offer various surgical options to women with recurrent or advanced uterine cancer, and our outcomes following surgery in these cases are among the best in the world.
Because uterine cancer develops in the lining of the uterus, in many cases we advise women to have the organ removed through a procedure called a hysterectomy. Usually the surgeon removes the fallopian tubes and ovaries along with the uterus in a procedure known as bilateral salpingo-oophorectomy. Some of the pelvic lymph nodes may also be removed and examined to find out whether the cancer has spread to other parts of the body.
The most common approach to this surgery — total abdominal hysterectomy (removal of the uterus through an incision in the abdomen) — can be done via traditional means or through a minimally invasive strategy that offers benefits such as reduced risk for infection and a shorter hospital stay.
Minimally Invasive Surgery — Laparoscopic & Robotic Approaches
Although not all patients are candidates, the majority of hysterectomies at Memorial Sloan Kettering are performed using laparoscopic- or robotic-assisted techniques in which the uterus and other tissues are removed through the vagina using very small incisions in the abdomen.
Your Memorial Sloan Kettering surgeon will discuss using these techniques and what approach is best suited to your situation. Women who undergo laparoscopic or robotic surgery often have shorter hospital stays, faster recoveries, and fewer complications than those who have traditional open abdominal surgery.
With laparoscopic surgery, the surgeon first examines the pelvic cavity with a laparoscope — a thin, lighted tube with a video camera at its tip — which projects an image onto a large viewing screen. Guided by the laparoscope, the surgeon operates through tiny surgical “ports” (small tubes placed into the abdomen) using specially designed instruments to remove the uterus through the vagina.
With robot-assisted laparoscopic vaginal hysterectomy, specially trained surgeons use an advanced robotic device — called the da Vinci Surgical System® — to assist them during the procedure. To use the robot, a surgeon is seated at a multifunctional console positioned next to the patient. He or she views the area of the operation on the console via a magnified, three-dimensional, high-definition visual system.
The surgeon performs the operation using finger and foot controls on the console, with the robot precisely copying his or her every movement. As the surgeon uses the robot to operate, the surgical team at the bedside monitors the patient throughout the procedure, assisting as necessary.
Combining Panniculectomy with Uterine Cancer Surgery
Obesity is common among women with uterine cancer. In certain cases, our gynecologic surgeons collaborate with plastic surgeons to combine hysterectomy and staging with a reconstructive procedure known as panniculectomy, or “tummy tuck,” to remove excess skin and underlying fat in the abdominal area. This option for combination surgery is associated with better staging results and fewer complications.
Sentinel Lymph Node Mapping
At Memorial Sloan Kettering, we have pioneered an approach called intraoperative lymphatic mapping, or sentinel lymph node biopsy, which enables us during surgery for women with early-stage cancer to remove only those lymph nodes that contain cancer cells. Lymph nodes play an important role in draining fluids and fighting infection, and avoiding their removal reduces the risk of lymphedema (swelling) in the groin and legs.
Our team is continuing to explore new approaches to sentinel node mapping that improve patient care and reduce treatment side effects.
Surgical Options for Women with Advanced Cancer
Some women whose advanced uterine cancer has spread to other abdominal organs may need an extensive surgery known as pelvic exenteration. In this surgery, all the reproductive organs are removed, and the bladder, urethra, and rectum may also be removed. Surgeons then reconstruct the organs so the patient retains optimal function. This is a radical procedure reserved for women with limited treatment options.