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Gynecology & Obstetrics

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Surgery

Dr. Edward Tanner at the microscope

Many women diagnosed with gynecologic cancer are candidates for surgery as their primary treatment. Surgical removal of a tumor, along with any other distant growths, significantly increases a woman’s chances of survival. At the Johns Hopkins Kelly Gynecologic Oncology Service, we offer superior surgical expertise in both radical surgery for advanced cancer and innovative minimally invasive surgical approaches for early-stage disease. Learn more about preparing for surgery.

When appropriate, we make use of minimally invasive surgical procedures, including robotically-assisted technologies to manage early-stage uterine, cervical and ovarian cancers, and certain types of pelvic masses. We are experts in laparoscopy and single-incision laparoscopic surgery. More than 95 percent of our patients with these conditions are treated with minimally invasive surgery — more than any other program in the region. With minimally invasive surgery, there are fewer surgical complications, less pain, less blood loss, decreased chance of infection, less scarring and shorter hospital stays. Learn more about our surgical treatments for gynecologic cancers:

Minimally Invasive Surgical Innovations

At the Johns Hopkins Kelly Gynecologic Oncology Service, we strive to provide our patients with the most progressive care possible. Through our innovative surgical approaches, we are able to tailor treatments to individual patients to achieve the best possible outcomes. For many patients, this includes minimally invasive surgery. In minimally invasive, or keyhole, surgery, the surgeon is able to perform abdominal procedures through tiny incisions, rather than one large incision. These procedures allow patients to recover more quickly and with fewer complications than traditional open surgery. Our surgeons use conventional laparoscopy, vaginal approaches and robotics to perform minimally invasive surgery, and will use the approach that is most appropriate for each patient. In many cases, we can perform complex procedures, including radical hysterectomy for cervical cancer and resection of recurrent ovarian cancer, with minimally invasive techniques not offered at most centers.

In some cases, we are even able to perform procedures through one 1-inch incision in the bellybutton. Although not appropriate for all patients, single-incision surgery can result in an improved cosmetic result, as the scar is hidden in the bellybutton. In addition, single-incision surgery may be associated with less postoperative pain than multi-incision surgery. Edward Tanner, M.D., is the first surgeon in the world to report performing a radical hysterectomy and sentinel lymph node mapping using the robotic single-incision platform. He continues to lead research with this exciting new approach.

We believe that offering minimally invasive surgery to as many patients as possible is an important part of providing high-quality care. Led by Amanda Fader, M.D., a recent nationwide investigation found that only 33 percent of patients undergoing hysterectomy for the treatment of endometrial cancer had their procedure performed with a minimally invasive approach in the United States. Kelly Gynecologic Oncology Service faculty members are proud of the fact that we perform minimally invasive surgical procedures in approximately 85 percent of patients referred to us with a diagnosis in endometrial and cervical cancers — among the highest rates of minimally invasive surgery in the nation. This results in shorter hospital stays, fewer complications and a much faster recovery, without compromising cancer outcomes or patient survival. With our progressive and personalized approach to surgery, the surgeons of the Kelly Gynecologic Oncology Service are dedicated to providing women with the best possible outcomes and always putting patients first.

Sentinal Lymph Node and Diagnostic Innovations

One of the first places endometrial cancer spreads is to the lymph nodes in the pelvis and around the uterus. Until recently, the only option to determine if these lymph nodes contain cancer is to remove all of the nodes around the uterus. This procedure, called a pelvic lymph node dissection, results in longer surgical times, more blood loss and risk of lymphedema in the legs. Lymphedema, or swelling in the legs, impairs quality of life, even in patients that survive their diagnosis. The National Comprehensive Cancer Network has recently approved sentinel lymph node mapping as an alternative to pelvic lymph node dissection. With sentinel lymph node mapping, only the lymph nodes most likely to contain cancer are removed. These lymph nodes are identified by injecting a special dye into the cervix and examining the lymph nodes with a special infrared camera at the time of surgery.

The Sentinel Lymph Node Mapping Program at Johns Hopkins was started by Edward Tanner, M.D., in 2012 and has quickly grown into one of the largest sentinel lymph node mapping programs in the world. Tanner was the first to report the benefits of using infrared imaging to perform sentinel lymph node mapping for endometrial cancer. He has recently developed a new sentinel lymph node algorithm that will hopefully reduce the rate of lymph node dissections for endometrial cancer from 30 percent to less than 10 percent. The goal of this algorithm is to reduce the risks of lymph node dissection — most importantly, the risk of lymphedema. In some patients, Tanner and our physicians are able to combine the sentinel lymph node algorithm with single-incision robotic surgery to potentially improve the recovery time from surgery. Future research efforts will hopefully lead to a greater proportion of patients undergoing surgery for endometrial cancer, with lower risks of developing a complication.

Radical Cytoreductive ("Debulking") Surgery

Surgery is an essential element in the journey of a woman with gynecologic cancer. Initially, an operation is often necessary to make an accurate diagnosis and determine how advanced the cancer is. This process is known as staging. The goal of surgery is to remove as many of the cancerous tumors as possible, which may involve performing radical cytoreductive (“debulking”) surgery, including removal of the bowel, bladder and spleen, and portions of the stomach, liver or other organs. Because surgery is integral to the diagnosis and management of a gynecologic cancer, partnering with an expert surgical team is critical.

You’ll find that expertise and innovation at the Kelly Gynecologic Oncology Service at Johns Hopkins. We possess years of in-the-trenches experience, consistently using the most advanced and effective methods of surgery and cutting-edge tools. Our gynecologic oncology surgeons are cross-trained in multiple surgical disciplines, including urology, colorectal surgery, gynecology, minimally invasive surgery and surgical oncology. It has been understood for more than a decade that women with advanced ovarian, primary peritoneal and uterine cancers benefit from radical cytoreductive (or “debulking”) abdominal surgeries to remove all or most of the grossly visible cancer. Our gynecologic oncologists who perform these complex surgeries are leaders in surgical care and have led or co-authored studies that inform the most recent surgical advances for ovarian cancer. In fact, studies from Kelly Gynecologic Oncology Service surgeons and others demonstrate the tremendous survival advantage that women with advanced-stage ovarian and uterine cancer have when they undergo surgery from a high-volume gynecologic oncology surgeon and when all or most of the tumors are removed, known as an optimal cytoreductive surgery.

But an excellent surgical outcome is not just about having access to the most skilled surgeons — it’s about having an expert multidisciplinary team care for you. This team includes exceptional anesthesiologists, pathologists, intensive care unit providers, radiologists and oncology nursing care, and social work support. Our multidisciplinary surgical and oncology teams at Johns Hopkins will provide you with seamless and unparalleled care and support during your stay with us.

Enhanced Recovery After Surgery Program

Johns Hopkins Medicine is a recognized leader in quality and patient safety. Our surgeons are pleased to include you in our Enhanced Recovery After Surgery (ERAS) program. Our program combines several interventions aimed at minimizing the stress of surgery on your body. It specifically addresses factors that delay recovery after surgery, such as slow return of bowel function, immobility and pain. Our unique program has been specially designed for you by our team of expert surgeons, anesthesiologists, pharmacists and nurses. Studies show that patients given the opportunity to participate in ERAS programs experience faster functional recovery and shorter lengths of stay after surgery. They are also less likely to suffer from complications that often require readmission to the hospital. The material included in this education book will provide you with an overview of the exceptional surgical experience we offer at Johns Hopkins through our ERAS program.

Fertility-Sparing Surgery

Our expertise in minimally invasive surgery includes fertility-sparing procedures that allow select women to keep their reproductive organs or freeze their eggs or embryos (known as cryopreservation) to preserve the potential for future fertility. Your gynecologic oncologist will make a decision on whether to perform a fertility-sparing surgery based on your age, fertility-goals, and type and stage of cancer. Even if a fertility-sparing surgery is not recommended, you may still have the option of undergoing one of our other fertility preservation services.

Request an Appointment 

To find out if you are a candidate for robotic laparoscopic surgery, make an appointment with one of our gynecologic oncologists by calling 443-997-0400.