Surgery 1

If a patient has cytoreductive/debulking surgery but decides not to remove ovary/ovaries and/or uterus for fertility preservation reasons, you may still count the surgery (for example: bilat salpingectomy, LT oophorectomy, RT ovarian cystectomy, removal of bilat pelvic masses, lysis of adhesions and oversew of bowel serosa) as a cytoreduction/debulking surgery.

Minimally Invasive Surgery (MIS) 

During a Minimally Invasive Surgery (MIS), a small incision in the abdomen to insert a laparoscopic camera and various instruments, unlike conventional open surgery with a large incision.  For a robotic-assisted hysterectomy, the surgeon performs with the help of a robotic machine (da Vinci surgical system).  The surgeon controls the robotic arms with a controller while looking at a screen. 

• Examples of common MIS in gynecologic oncology are:Total Laparoscopic Hysterectomy(TLH/Laparoscopic Hysterectomy, Robotic Assisted Laparoscopic Hysterectomy (RALH), Vaginal hysterectomy, and Vulvectomy.
  • Total Laparoscopic Hysterectomy (TLH/Laparoscopic Hysterectomy): This is the laparoscopic ligament detachment of the uterine fundus and cervix. The uterus is often removed via the vagina, but alternatively, may be removed through the abdomen. Removal of the uterus may require bivalving, coring, or morcellating especially if the specimen is removed vaginally, or the uterus may be removed through a small abdominal incision or trocar site. The vaginal cuff may be closed either laparoscopically or vaginally.
  • Robotic Assisted Laparoscopic Hysterectomy (RALH): A procedure like a laparoscopic total hysterectomy, except that the specialized laparoscopic instruments are connected to robotic arms. This allows the surgeon to have enhanced dexterity and visualization. In the body of the operative report, look for a description of the robot being “docked” or “undocked”.
  • Vaginal hysterectomy is performed entirely through the vaginal approach. The procedure is completed through a circumferential incision around the cervix (frequently called the “colpotomy” in operative reports) and involves the removal of the cervix and uterine fundus.
  • Vulvectomy is surgery in which a surgeon removes all or part of the vulva. The vulva includes the inner and outer labia. If a vulvectomy is described as anterior or posterior, choose “bilateral”

Open Surgical Approach

An OPEN surgical approach involves cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure. This approach allows the surgeon a full view of the structures or organs involved. A Total Abdominal Hysterectomy (TAH) and a Laparotomy are two common open surgical procedures in gynecologic oncology. A patient may also require a Bowel Surgery, Splenectomy, or diaphragm surgery in order to achieve optimal cytoreduction/debulking.

• If a gynecologic oncology surgical case is performed entirely  robotic/laparoscopically but a mini-laparotomy is performed for specimen removal, abstract the case as Minimally Invasive Surgery and choose either Robotic or Laparoscopic.

If a gynecologic oncology surgical case begins as robotic/laparoscopic and is converted to an open procedure (due to the amount of disease found or the need for debulking) abstract the surgery as Open.