Minimally Invasive Surgery for Ovarian Cancer: What to Expect

Surgery for ovarian cancer is frightening but there have been major advances that make these procedures somewhat less traumatic.

In traditional surgery for ovarian cancer, doctors make a large incision in the abdomen in order to ensure they’ll have enough access to the organs of the abdomen and pelvis, with plenty of visibility and space to properly use their hands and surgical instruments. But now, explains Dr. Daynelle Dedmond, a gynecologic oncologist for Centura in Colorado Springs, there are minimally invasive techniques that can leave patients with much less scarring and an easier recovery. This new type of surgery, she adds, can be done through incisions as small as five millimeters (a fifth of an inch).

“Minimally invasive surgery is laparoscopic surgery,” says Dr. Dedmond, meaning it’s performed using a slender, lighted tube that can be inserted through a very small incision in the abdomen or pelvis. While the abdominal incisions for laparoscopic surgery are much smaller than for traditional surgery, doctors need multiple incisions to perform the procedure. Each small incision allows a light or a surgical tool access to the internal organs.

In the newest version of this surgery, laparoscopic surgery can be done with robot assistance. “With laparoscopic surgery without a robot, the surgeon is at your side working the instruments with their own hands,” says Dr. Dedmond. “If we’re using the robot, the surgeon is on a console where they can see very clearly how to control the robot to do the surgery up close with fine dissection.”

The surgical robots are a tool that can provide several advantages. “They offer the surgeon the ability to move the organs around and see into areas that we previously couldn’t see into,” says Dr. Dedmond. “And with the additional arms, we’re not just relying on our own hands and our assistant’s hands. Sometimes during surgery you wish you had a third hand, or a fourth, and with the robot you do. You’re able to work all of those hands, move each of those arms independently. And that can help the surgeon hold up organs or move aside organs in order to see where the cancer is…or isn’t.”

Another difference between traditional and laparoscopic surgery is that for the latter, carbon dioxide gas is used to distend the abdomen and make the organs easier to see. Patients undergoing laparoscopic surgery are often placed in a different position than in traditional surgery. The body may be inclined with the head down and the feet elevated in what’s called a Trendelenburg position, which helps the surgeons see more clearly into the pelvis.

Because of the position changes and the use of carbon dioxide gas, patients may experience different side effects after laparoscopic surgery. “These side effects are usually minimal,” says Dr. Dedmond. “Sometimes carbon dioxide gas is retained for a little while up under the diaphagm, and may feel like pain in the arm, shoulder, or back.” In addition, she says, there may be some swelling in the upper extremities. “All these side effects go away quickly, in the first few days after surgery,” she says. “And in general the side effects and the pain are much less than in a traditional laparotomy—the type of surgery where we make a full incision.”

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