Gynecologic oncology is a critical branch of gynecology that focuses on the prevention, diagnosis, and treatment of neoplasms in the female genital organs. These neoplasms include both benign and malignant tumors, such as cancer.

“Minimally invasive techniques (MIS) in gynecologic oncology were developed to address surgical problems with maximum efficiency while minimizing intervention and disruption to the human body. Minimally invasive surgery includes classic and robotically assisted laparoscopy, also known as robotic surgery, techniques that allow the operation to be completed through small incisions in the abdomen, using a camera and monitor, as well as special tools,” says Mr. Stylianos Ivros Clinical Director of Gynecology & Gynecological Oncology Metropolitan Hospital and explains how such an operation is performed and its benefits for patients:

Which gynecological oncological conditions can be treated with robotic surgery?

Available robotic and effective therapeutic techniques in gynecologic oncology include:

• Surgical management and treatment of endometrial cancer
• Surgical management and treatment of incipient ovarian cancer
• Surgical management and treatment of borderline ovarian tumors
• Surgical management and treatment of uterine sarcomas
• Fertility preservation strategies in young patients with gynecological cancers

Does minimally invasive surgery have the same results as the classic method?

As the years pass, more and more surgical operations are performed using modern techniques, among them the laparoscopic, but also the robotic method, which include either a smaller incision compared to the traditional operation, or an operation without any incision, depending on the chosen technique.

“When the surgeon has sufficient experience and the operation can be performed either way, the minimally invasive technique is usually chosen, as it offers less risk of infection, shorter recovery time, reduced cost and a more effective result.

In fact, in some cases, it may start with a modern technique and then, depending on the findings, the surgeon may decide to make a larger incision for easier management and a more successful operation,” he points out.

What are the main advantages of minimally invasive surgery?

The major advantages of robotic surgery in gynecologic oncology are:

• Surgical precision
• Less blood loss and reduced need for transfusions
• Faster recovery
• Minimization of hospitalization time
• Minimization of postoperative pain and complications
• Excellent aesthetic result and smaller incisions
• Quick return to the person’s normal activities
• Reduced risk of infection

How are modern, almost bloodless, surgeries performed?

“Modern, almost bloodless procedures are performed through laparoscopic surgery, which allows surgery on the internal organs of the human body through small holes that do not require large incisions. This is made possible by the use of special tools and the use of video, while the operation begins with a small incision in the navel area. Carbon dioxide gas is then infused into the abdomen to “inflate” the abdominal wall, thereby creating space and ensuring good visual access. The use of ergonomically and technologically advanced tools contributes to the effective performance of the operation,” he adds.

How is robotic surgery performed?

At the Metropolitan Hospital, the advanced Da Vinci robotic system is used for surgical operations. The machine consists of a robot with arms that is placed next to the operating table and adjusted to the patient. The surgeon sits at the operating console and controls the robotic arms with precision in order to safely perform the operation through small incisions. The robotic system transfers the movements to the surgical field, operating with millimeter precision, performing the required movements with absolute safety.

What is the sentinel lymph node technique in gynecological malignancies?

The sentinel lymph node technique is an important tool in gynecologic oncology, which allows the staging of malignancies with high sensitivity, especially in cancers such as endometrial cancer, where its use can reach and exceed 98%.

• How does this particular technique work?

In practice, this procedure involves resection and biopsy of the lymph node in order to determine whether the cancer has spread beyond the original tumor in the lymphatic system.

The method is based on the observation that the sentinel lymph node is the first destination of the disease, i.e. the first lymph node to receive cancer cells. By locating this lymph node and checking for the presence of cancer cells, we can accurately determine if the disease has progressed.

This information is critical for staging the disease, offering important guidance for choosing the next therapeutic approach. At the same time, it frees patients from extensive lymphadenectomy, which increases the risk of lymphedema in the lower extremities by up to 30%, during the first two years after surgery.

In which gynecological malignancies can it be applied?

The sentinel lymph node method has been used for many years in the treatment of vulvar cancer, cervical cancer and more recently endometrial cancer, with the encouraging results mentioned above.

Also, this technique has been widely applied in surgical oncology, such as breast cancer, melanoma and others, with success for decades.

What are the individual advantages of this technique?

“The above method has two important advantages. First, by using a specific dye, we can detect even cancer cells that have started to move from the main tumor to other places. Second, we can obtain the maximum amount of information about the tumor with the minimum possible surgical cost. This means we can offer the patient the correct, customized treatment she needs,” concludes Mr. Ivros.

*The Metropolitan Hospital has the Gynecology & Gynecological Oncology clinic which is fully equipped with the most modern machines in the field of diagnostic and therapeutic equipment. The clinic operates under the supervision of an excellent scientific and nursing staff, which has the ability to deal with even the most demanding diagnostic and therapeutic issues. More specifically, the hospital operates a Gynecology & Gynecological Oncology Clinic, which was created to help prevent and treat diseases of the internal and external genital organs. In this department, all Gynecological Oncology procedures are carried out, with specialized surgeries and full support from the hospital’s Oncology Board, offering the most up-to-date and effective treatment and therapeutic approach.