Robotic Pelvic Lymph Node Dissection

at Sterling Hospitals

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at Sterling Hospitals

Schedule Your Appointment Online

Overview

What is Cervical Cancer?

The cervix is the lower part of the uterus (womb). Cervical cancer happens when abnormal cells in the cervix grow out of control.

What Causes Cervical Cancer?

Persistent Human papilloma virus (HPV) infection
Smoking
Weak immunity

Who is at Risk?

Women aged 30–60 years
HPV infection
Having HIV infection
Smoking
Using a contraceptive pill
Having a family history
Lack of regular screening

Symptoms of Cervical Cancer

Abnormal vaginal bleeding
Bleeding during or after sex, between periods or after menopause
Pain between the hip bones (pelvis)
Unusual vaginal discharge

How is it Diagnosed?

Pap smear — checks for early cell changes
HPV test — looks for Human papillomavirus
Colposcopy — closer examination of the cervix
Biopsy — small tissue sample for confirmation

How is this Condition Managed?

Surgery: hysterectomy, radical trachelectomy, lymphadenectomy (removal of lymph nodes in the pelvis)
Pelvic lymph node dissection may be done during surgery
Chemotherapy (drugs to kill or stop the growth of cancer cells)
Radiation therapy (high-energy radiation to halt cancer cell growth)
Chemotherapy and radiotherapy together (chemoradiotherapy)
Immunotherapy (helping the immune system fight cancer)
Immunotherapy with chemotherapy

Overview of Pelvic Lymph Node Dissection

What is it?

If the cancer has spread further into the tissues of the cervix, removal of pelvic lymph nodes (that lie deep inside your belly, between the hip bones) is done to check cancer spread. Many of the cells that help fight infections live within the lymph nodes. Lymph nodes also collect cancer cells that have broken away from the main tumour.

Why is it Done?

Detect cancer spread
Guide treatment planning

Types of Surgery

Open surgery: Large cut on the belly.

Laparoscopic (keyhole) surgery: Small cuts using a camera.

Robotic (robot-assisted) surgery: Very small cuts using robotic instruments controlled by the surgeon.

Benefits of Robotic Surgery

Robotic surgery is a promising option as it can lower complications while still removing enough lymph nodes effectively.

Less pain
Less blood loss
Faster recovery
Better precision

Comparison of Surgical Approaches

Parameter	Open	Laparoscopic	Robotic
Visualisation	Standard view	2D/limited 3D	High-definition 3D, 10x magnified
Precision and dexterity	Limited by manual technique	Limited instrument mobility	Enhanced precision
Lymph node yield	Comparable or slightly higher	Comparable	Comparable or higher vs laparoscopy
Blood Loss	Higher (~200–2000 mL)	Lower than open	Significantly lower blood loss
Post-operative Pain	More	Less than open	Less post-operative pain
Hospital Stay	Longer	Shorter	Shorter hospital stay
Recovery Time	Slower	Faster than open	Faster recovery
Complications	Higher risk	Reduced vs open	Lower complication rates
Operative Time	Shorter	Moderate	Often longer operative time
Cosmesis (Scars)	Large incision scar	Small scars	Minimal scars
Oncological Outcomes	Established standard	Comparable	Comparable (recurrence and survival)

Procedure Details

Instructions Before the Procedure

BP, pulse and temperature will be checked
Doctor will review your medicines
Inform about allergies
You will be asked to fast before surgery
Bowel preparation (cleaning the bowels before surgery) may be advised

Step-by-Step Overview

You will be given general anaesthesia (put to sleep)
Small cuts are made in your belly
The surgeon uses robotic arms to remove the targeted lymph nodes
Nearby nerves and blood vessels are protected
Cuts are closed
The removed nodes are sent to the lab for testing

Duration

The surgery usually takes 2–4 hours.

After the Procedure

Monitoring of vitals
Pain management
Early movement is encouraged
Eating and drinking is resumed
Drain monitoring (if present)
Blood-thinner injections may be given
Compression stockings are advised

Recovery and Aftercare

Short hospital stay (1–3 days).

Recovery Timeline

Return to routine in 2–4 weeks.

Follow-up Schedule

Every 3–6 months initially.

Benefits and Outcomes

Expected Results

Removal of greater number of pelvic lymph nodes
Less blood loss
Lower risk
No compromise in quality of lymph node removed

Risks & Complications

Common Risks Post-Surgery

Mild bruising or bleeding around the wound site
Infection
Bloating, stomach discomfort
Leg swelling

Red Flag Symptoms

Seek help if there is:

Persistent bleeding
Uncontrolled pain
Fever ≥ 37.5°C
Redness/swelling/discharge
Blackened skin

Lifestyle and Prevention

Avoid heavy lifting for a few weeks
Start gentle walking early and stay active
Eat a healthy, balanced diet
Keep your wound clean and dry
Wear compression stockings if advised
Take prescribed medications, blood thinners (if any) regularly
Maintain a healthy weight

Preventing Recurrence

HPV vaccination
Regular screening
Quit smoking

Myths vs Facts

Myth

The robot performs the pelvic lymph node dissection on its own.

Fact

The surgeon is always in control; the robot only assists movements.

Myth

Lymph node removal always causes swelling (lymphedema).

Fact

Not everyone develops swelling; risk varies from person to person.

Myth

Robotic surgery for pelvic lymph node dissection is unsafe.

Fact

It is considered safe and widely used when performed by trained surgeons.

Myth

Recovery after robot-assisted pelvic lymph node dissection takes a long time.

Fact

Recovery is usually faster with minimally invasive (robotic) surgery.

Frequently Asked Questions

Is robotic surgery for pelvic lymph node dissection safe?

Yes, it is safe when performed by experienced surgeons.

How long will I stay in hospital?

Usually 1–3 days, depending on recovery.

When can I return to normal life?

Most people recover in 2–4 weeks.

Will I need further treatment?

This depends on your test results after surgery.

Can swelling (lymphedema) happen?

Yes, but not everyone gets it, and proper care can reduce the risk.

Will I have pain after robotic surgery?

Some pain is normal, but it is managed with medicines.

References

1. World Health Organization. Cervical Cancer. Available from https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
2. Cancer Research UK. Risks and causes of cervical cancer. Available from https://www.cancerresearchuk.org/about-cancer/cervical-cancer/risks-causes
3. National Health Service. Available from https://www.nhs.uk/conditions/cervical-cancer/
4. American Cancer Society. Cervical Cancer Early Detection, Diagnosis, and Staging. Available from https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging
5. Cancer Research UK. Treatment options for cervical cancer. Available from https://www.cancerresearchuk.org/about-cancer/cervical-cancer/treatment/treatment-decisions
6. Robotic surgery. Available from https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974
7. Lu Y, Chen J, Wei R, et al. Application of robotic surgery and traditional laparoscopic surgery in lymph node dissection for gynecological cancer: A meta-analysis. Oncology Letters. 2023;25(5):175.
8. Eissa A, Sighinolfi MC, Elsodany I, et al. Robotic Pelvic Lymphadenectomy in Gynecological and Urological Malignancies. Clin Exp Obstet Gynecol. 2023;50(6):123.
9. Göçmen A, Şanlıkan F, Avcı ME. Robotic-Assisted Dissection of Bulky Lymph Nodes in Cervical Cancer. Case Rep Obstet Gynecol. 2014;2014:965698.
10. Pelvic lymphadenectomy. Available from https://massivebio.com/pelvic-lymphadenectomy-bio/
11. Kim YT, Kim SW, Hyung WJ, et al. Robotic radical hysterectomy with pelvic lymphadenectomy for cervical carcinoma: a pilot study. Gynecol Oncol. 2008;108(2):312–6.
12. Robotic pelvic node dissection for penile cancer. Available from https://www.christie.nhs.uk
13. Cancer Council. Reducing your risk of lymphoedema. Available from https://www.cancercouncil.com.au/cancer-information/managing-cancer-side-effects/lymphoedema/reducing-your-risk-of-lymphoedema

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