Robotic-assisted minimally invasive surgery and ovarian cancer

Ovarian cancer is the fifth most common cancer in women, and the most lethal gynecologic malignancy in western countries. Approximately 70% of malignant ovarian cancers are diagnosed with diffuse intraperitoneal spread. The treatment algorithm for ovarian cancer consists of the combination of maximal cytoreductive surgery and chemotherapy [1]. Advanced stages, requiring major tumor debulk ing, represent a different challenge for the minimally invasive surgical approach compared with early ovarian cancer that requires removal of the tumor and staging. The surgical approach for the treatment of ovarian cancer has classically been performed through a midline incision. Treatments include: hysterectomy, bilateral salpingo-oophorectomy, omentectomy with or without pelvic and/or para-aortic lymphadenectomy, pelvic washings, peritoneal and diaphragmatic biopsies and removal of any macroscopic resectable disease. This is then followed by adjuvant chemotherapy either intravenously or intraperitonealy with a platinum derivative and a taxane. Following presentation of the EORTC-GCG/NCIC-CTG randomized trial comparing primary debulking surgery with neoadjuvant chemotherapy in advanced ovarian cancer, neoadjuvant cytoreductive chemotherapy followed by interval surgery has become an alternative approach to major upfront debulking surgery. This has paved the way for the introduction of minimally invasive surgery in the treatment algorithm of advanced ovarian cancer [2].