Who should have robot-assisted hysterectomy?
There are many ways to treat gynecological cancers including radiation, chemotherapy, hormone therapy and surgery. However, robotic surgery can yield faster recovery times and more thorough healing.
Certain characteristics of patients are looked at to determine if they are eligible for robotic surgery.
The chance of getting gynecological cancer increases as you get older. One thing many patients worry about is whether they are too old to have surgery. At Roswell we follow national guidelines regarding treatment options based on the National Comprehensive Cancer Network. According to those guidelines we calculate your life expectancy based on your age as well as your other medical conditions. At Roswell Park, we have operated on patients in their 20’s up to their 80’s. Age alone will not disqualify a patient from robotic surgery, but we screen patients very carefully for other medical conditions that would influence the risk of undergoing surgery.
Another factor that’s taken into account when considering surgery is a patient’s weight. Usually, doctors look at a calculation called the Body Mass Index, or BMI, that takes both height and weight into account. The range of BMI values for people whose weight is considered average is 18.5-25. If a person’s BMI is lower than this, they’re underweight; if it’s higher, they’re overweight. If the BMI is over 30, they’re considered obese. Being overweight or obese will not disqualify a patient from undergoing robotic surgery, and often overweight patients will benefit from the advantages of a minimally invasive surgical approach.
Medical history is important when considering surgery. Anesthesiologists use the “ASA” score to classify patients prior to surgery based on medical history. This is an overall estimation of your physical health, based in part on whether or not there is systemic disease (problems with one of the body’s main systems). ASA scores are given in Roman numerals:
ASA I: a normal, healthy patient
ASA II: a patient with mild systemic disease, such as someone with well-controlled high blood pressure
ASA III: someone with severe systemic disease that interferes with their normal functioning
ASA IV: someone whose disease puts them at constant risk: for example, a person with a combination of serious illnesses
Uterine (or pelvic mass) size
In order to perform a surgery robotically, it is important to remove the malignant uterus (and/or pelvic mass) in one piece to minimize the risk of spreading cancer. Therefore, patients with a GYN malignancy who qualify for robotic surgery will tend to have a uterus less than 12-14 cm.