University of Chicago offers newest high-tech, minimally invasive surgery to battle endometrial cancer

April 23, 2007

The University of Chicago Medical Center now offers robotic surgery for endometrial cancer. Sarah Temkin, MD, assistant professor of obstetrics and gynecology, is the first gynecologic oncologist in Illinois to operate with Intuitive Surgical's da Vinci robotic system.

Endometrial cancer has traditionally been treated with a hysterectomy and removal of lymph nodes performed through an open 6 to 10-inch incision. In recent years, minimally invasive laparoscopic surgery has become a viable option for hysterectomies and lymph node sampling, but surgeons are only now beginning to adopt and adapt the robotic system for gynecologic surgeries.

At the University of Chicago, surgeons have used the surgical robot to perform prostatectomies and many other operations since 2003. It quickly became a preferred method for surgical treatment of prostate cancer because it was a minimally invasive surgery with clear visualization and very precise control.

Unlike traditional laparoscopic surgery, the robot uses a "stereo" camera that provides depth perception. The three-dimensional, magnified view allows surgeons to see how deep they have gone and the proximity to blood vessels.

"I, as a surgeon, have control over everything without actually having my hands in the patient's abdomen," said Temkin, who joined the medical center last autumn after extensive minimally invasive surgical training during her gynecologic oncology fellowship. "It's like driving a stick shift."

The surgeon sits in front of a console that provides a three-dimensional image of the area of operation. He or she wears "gloves" that contain sensitive sensors and directs the motion of the robot's hands. Those hands have wrists that pivot 180 degrees and control the surgical instruments.

"With these instruments, you have much greater range of motion than you do with traditional laparoscopic instruments. The articulation of the wrists alone makes you so much more facile," Temkin said. "Clinical evidence is still very preliminary, but there appears to be less blood loss, fewer complications and patients experience less pain."

Case in point, last November, doctors diagnosed Pamela Koher with endometrial cancer. When she met Temkin, she was glad to see a young surgeon. "Young people see how this works," Koher said. "They love it. They've been playing video games since they were little."

Although Koher had a complete hysterectomy and18 lymph nodes removed from along the large blood vessels that feed the pelvis, she stayed in the hospital for only one night. By the fourth day after the surgery, Koher felt like herself again. Within two and a half weeks, she had resumed her usual schedule and returned to work as a dental hygienist. Patients who have a traditional open surgery usually will not be back to work for 6 to 8 weeks after surgery.

In Koher's case, no chemotherapy or radiation was needed. The only visible signs of the surgery are five half-inch scars on her abdomen. "I can't say I was in pain," Koher said. "I felt good about having the minimally invasive surgery."

The National Cancer Institute predicts more than 39,000 new cases of endometrial cancer will be diagnosed in 2007. They also estimate 7,400 deaths.

In the United States, endometrial cancer is the most common cancer of the female reproductive organs. According to the American Cancer Society, 70 percent of women diagnosed with this illness are between the ages of 45 and 74. Overall, the five-year survival rate for endometrial cancer is 84 percent.

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