A New Approach: Providing women with gynaecological cancer a minimally invasive surgical option

TORONTO -- Surgical oncologists Al Covens and Rachel Kupets at Odette Cancer Centre (TSRCC), the comprehensive cancer program of Sunnybrook Health Sciences Centre, are two of only a few surgeons in North America qualified to perform complex laparoscopic gynaecological operations for women with uterine, cervical and ovarian cancer.

"Rather than making a large incision that requires up to six weeks to recover from, we can do the entire operation through four small incisions," says Kupets. "Women are able to go home later that evening or the next day, require little or no pain medication and move forward with their cancer treatment immediately."

Using a laparoscope, a one centimetre incision is made allowing for a fibreoptic camera to be inserted directly in to the abdominal cavity. The images are projected onto monitors allowing the surgical team to view the operation field. During the procedure, surgeons are able to determine the extent of the cancer by obtaining tissue samples of the tumour, lymph nodes and surrounding areas for biopsy. If possible, the surgeon will remove the tumour and affected areas.

Complicated gynaecological procedures such as a hysterectomy, the surgical removal of the uterus, can be performed using a laparoscope on an outpatient basis. A traditional hysterectomy which involves removing the uterus through an abdominal incision can be painful, require a hospital stay of up to five days, and most importantly can take more than six to eight weeks to recover from. A vaginal hysterectomy can be performed to remove the uterus however, surgeons are unable to evaluate the ovaries, lymph nodes and the rest of the abdominal cavity which limits the information they require to make well informed treatment decisions for women with gynaecologic cancers.

Theresa Robinson a 65-year-old grandmother of five from Whitby, Ontario is one of Dr. Kupets' patients. After losing her mother to ovarian cancer, Theresa could not shake the feeling that she too might have the disease. She decided to take matters in to her own hands. "I watched my mother die of this disease and I didn't want to go through that," says Robinson. After a series of appointments and tests doctors found a mass in her fallopian tube.

Immediately she was referred to the TSRCC. Three weeks later on November 4, 2005 just after noon hour Theresa underwent a laparoscopic removal of her fallopian tubes ovaries, pelvic lymph nodes, and omentum (a fatty apron that hangs off the large bowel). By 7:00 pm that same evening Theresa was back at home.

"The surgery left me with no after effects other than a few pinhole incisions that are fading away," says Robinson. "The day after the surgery, I was up and walking around."

On November 23, 2005 Theresa was back in to see Dr. Kupets and was prescribed six sessions of chemotherapy. The cancer was caught very early so her prognosis is good.

TSRCC is performing close to 300 laparoscopic gynaecological procedures a year on women of all ages who have been diagnosed with early cancers. For those who are diagnosed at a later stage other surgical options are more appropriate.