Robotic Salpingo-Oophorectomy (Removal of Ovaries and Fallopian Tubes) for Malignant Conditions

Robotic Surgery for Ovarian Masses, Early-Stage Ovarian Cancer, Endometrial Cancer and Cancer Risk Reduction.

Robot-assisted bilateral salpingo-oophorectomy (the surgical removal of both ovaries and fallopian tubes) is increasingly being used to treat a range of serious gynecologic conditions. Because robotic surgery combines the trauma-sparing benefits of a minimally-invasive procedure with superb 3-D, high-definition visualization and highly precise, computer-guided surgical capabilities, it can offer gynecologic surgeons a number of advantages—including the ability to remove abnormal tissue with great accuracy and, in some cases, work faster.

Benign Ovarian Masses and Early-Stage Ovarian Cancer

Robotic salpingo-oophorectomy has emerged as an important and effective surgical tool for treating ovarian masses that appear suspicious or that cause symptoms like pain or pressure. These masses may be either benign or malignant—something that is often determined by sending a frozen section to the pathologist while the patient is under anesthesia. If the mass is found to be benign, a straightforward procedure to remove the ovaries and fallopian tubes will be performed. If the mass appears to be malignant and the cancer is thought to be confined to the ovaries, robotic salpingo-oophorectomy will usually be utilized as one portion of the complete treatment and staging procedure for early-stage ovarian cancer. (For the full procedure, see Robotic Surgery for Early-Stage Ovarian Cancer.)

Endometrial Cancer

Robot-assisted surgery has also been widely accepted as an excellent surgical tool for the treatment of endometrial cancer. Salpingo-oophorectomy is a standard part of the complete treatment and staging procedure for this disease, and is performed in order to ensure that any microscopic cancer cells within the ovaries are eliminated. (For the full procedure, see Robotic Surgery for Endometrial Cancer.)

Cancer Risk-Reduction Surgery

Finally, a bilateral salpingo-oophorectomy may be performed as a preventive procedure for patients who are at high risk for developing either endometrial or ovarian/fallopian tube cancer due to hereditary predisposition. For such patients, this procedure dramatically decreases their overall risk for these cancers. In addition, the procedure can significantly reduce risk of breast cancer among premenopausal patients who have a significant family history of breast and/or ovarian cancer. While this procedure is similar to the surgical treatment for endometriosis and benign ovarian masses, the surgeon takes special care during robotic risk-reducing surgery to ensure that the entire fallopian tube is removed, due to the patient’s potential risk of developing a fallopian tube cancer.

Unilateral (Fertility-Sparing) Salpingo-Oophorectomy

If the patient’s benign ovarian mass is limited to just one ovary, it may be possible to perform a unilateral salpingo-oophorectomy, in which only the diseased ovary and fallopian tube are removed. This preserves the patient’s ability to become pregnant using eggs from her remaining ovary. Similarly, in some ovarian cancer cases where the cancer appears to be confined to just one ovary and the other ovary appears to be completely normal, the patient, in consultation with her gynecologic oncologist, may be able to safely opt for a unilateral salpingo-oophorectomy accompanied by a thorough surgical staging procedure. (For the full staging procedure, see Robotic Surgery for Early-Stage Ovarian Cancer.)

How Robotic Salpingo-Oophorectomy is Performed

In this procedure, four standard ports are placed in the patient’s abdomen using quarter-inch incisions, and the robot’s camera and instrument arms are inserted through the ports. Next, the surgeon locates the ovaries and the blood vessels that supply the ovaries, and also identifies the ureters (the tubes that carry urine to the bladder). The surgeon then uses the robot’s instrument arms to detach the ovaries and fallopian tubes from their blood supply and from their attachment to the uterus.

Advantages of Robotic Salpingo-Oophorectomy

Less scarring. When salpingo-oophorectomy is performed robotically, the dime-size incisions result in significantly less scarring than with an open procedure.
Less post-operative pain. The smaller incisions used in robotic salpingo-oophorectomy also result in less post-operative pain than the large abdominal incision employed in open surgery. In addition, there may be less manipulation of the incision sites when using the da Vinci Si surgical system compared to laparoscopic surgery. This may also contribute to decreased post-operative pain—something that is the subject of an ongoing prospective investigation by the gynecologic surgeons at NYU Langone’s Robotic Surgery Center.
Faster recovery and shorter hospital stay. Most patients undergoing robotic salpingo-oophorectomy are able to resume normal activities within 2 to 3 weeks, compared to 6 to 8 weeks for open surgery.
Superior visualization of the operating site. The magnified 3-D, high-definition image provided by the da Vinci Si surgical system enables excellent visualization of the ureters, blood vessels, and ovaries during surgery.

Robotic Salpingo-Oophorectomy at NYULMC

Our gynecologic oncology surgeons, Dr. Bhavana Pothuri and Dr. John Curtin, are two of New York’s top laparoscopic and robotic surgeons, and have spent many years perfecting minimally-invasive surgical techniques for the treatment of gynecologic cancers. During this time they have performed numerous robot-assisted salpingo-oophorectomies as part of their surgical treatments for ovarian masses, endometrial cancer, early-stage ovarian cancer, and as a risk-reducing procedure for the prevention of endometrial cancer, ovarian/fallopian tube cancers and breast cancer in patients at high genetic risk for these diseases.

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