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In ovarian cancer the extent of the disease, not the machine, chooses the operation. The robot earns its place when the cancer looks confined and every corner still has to be checked. Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad.
Last updated: 6 October 2026
Shah’s Gastro, Cancer & Robotic Surgery Centre. Fully qualified in surgical oncology, trained at high-volume cancer centres, and 18 years of experience in cancer surgery for women. Every ovarian, tubal or peritoneal cancer is discussed at the tumour board before the operation and its approach are named.
Ovarian, fallopian tube and primary peritoneal cancer are treated as one disease. Which operation it needs depends on how far it has spread, and the approach — robotic or open — follows from that, not the other way round.
When the cancer appears confined to the ovary or the pelvis, the operation is a complete staging: removing the womb, both tubes and ovaries and the omentum, sampling the lining of the abdomen and removing the lymph nodes of the pelvis and along the aorta. Dr Swati Shah does this robotically in suitable women, through small ports.
When the cancer has spread across the abdomen, the goal is to leave no visible disease, and that operation is done open. A smaller scar never takes priority over a complete removal.
The robot suits operations that need precise work in narrow spaces but do not need the whole abdomen opened: staging surgery for cancer that appears confined, and fertility-sparing surgery in carefully chosen young women. Widespread disease on the omentum, diaphragm and bowel needs an open operation.
Ovarian cancer spreads across the surfaces inside the abdomen — the omentum, the undersurface of the diaphragm, the coverings of the bowel. The operation for advanced disease is therefore an operation of surfaces: peeling, stripping and sometimes removing a segment of bowel or the spleen until nothing visible is left. That work is done open, with the whole abdomen in view and in reach.
Early disease is different. The cancer appears confined, yet hidden spread has to be searched for in the pelvis, in the lymph nodes beside the large blood vessels and on the surfaces of the upper abdomen. That search is careful, deep and narrow work, and it is where the robot’s view and wristed instruments help most.
The choice is made at the tumour board after the CT, the blood markers and the examination are reviewed together. It is not made because a patient asks for a small cut, and it is not withheld because the robot is more expensive. How the cancer was found and staged is covered on the ovarian cancer surgery page; this page is about the operation once the plan is surgery.
Staging is a set of steps, not a single cut. Each one either removes the cancer or looks for hidden spread, because the final stage is decided by what is found in the operation, not by the scan.
The operation begins, before anything is handled, by washing the abdomen with saline and sending the fluid to look for cancer cells. Then the womb, both fallopian tubes and both ovaries are removed. The omentum — the fatty apron that hangs from the stomach and is a common hiding place for spread — is removed below the colon. Small biopsies are taken from the lining of the pelvis, the sides of the abdomen and the undersurface of the diaphragm.
For disease that looks early, the lymph nodes of the pelvis and those running up along the aorta are removed systematically. In a mucinous tumour the appendix is removed as well. The ovarian mass itself is handled gently and placed in a bag so that it is not broken inside the abdomen.
Every one of these steps is the same whether the abdomen is opened or the operation is done robotically. The robot changes how they are done, not what is done.
Three things: a steady, magnified, three-dimensional view deep in the pelvis and along the aorta; instruments that bend at the tip, so the nodes can be cleared from around the blood vessels and the ureter at close quarters; and an extra arm that holds tissue still while it is divided.
The lymph nodes along the pelvic side walls lie on the iliac artery and vein, with the ureter — the tube from the kidney to the bladder — close by. Those along the aorta lie on the great vessels themselves. Clearing them is fine, slow work, and the magnified view shows the thin planes around the vessels clearly. The camera is held by the robot and steered by the surgeon, so it does not drift.
Bleeding is controlled as the dissection goes, with sealing energy and fine bipolar instruments, so blood loss is usually low. The abdomen is never opened along its length, so there is less pain after the operation, the patient walks and eats sooner, and the wound does not hold up the start of chemotherapy when chemotherapy is needed.
The robot has limits. There is no sense of touch through the instruments, and the operation takes longer in theatre than an open one. A large solid mass that cannot be placed in a bag whole is a reason to open, because breaking a cancer inside the abdomen spreads it.
The patient lies on her back with the legs supported apart and the head tilted down, so the bowel falls away from the pelvis. Small robotic ports are placed in a line across the abdomen, set higher than for a purely pelvic operation, because the arms must reach both the pelvis and the nodes along the aorta.
Positioning, padding and warming are completed before docking, because the patient cannot be moved once the robot is attached. An assistant port beside the robotic ones carries suction, the retrieval bag and the instruments that clip and divide larger vessels.
The operation starts with a full look at every surface of the abdomen — the diaphragm, the liver, the omentum, the bowel and its mesentery. If that look shows spread that the scan did not, the plan changes there and then: biopsies are taken, and the tumour board decides between chemotherapy first and an open operation. That possibility is explained before consent.
At the end every specimen is removed in a retrieval bag through a small opening, so no long wound is needed.
For a young woman who wants children, a cancer at the earliest stage, confined to one ovary, of low or intermediate grade and not of the clear-cell type, can be treated by removing only that ovary and its tube, with full staging of the rest. This is decided only after documented counselling.
The other ovary and the womb are left in place and inspected carefully; the omentum, peritoneal biopsies and nodes are taken as in a full staging, because the decision to keep fertility rests on proving the cancer has not spread. The robot suits this operation: the staging steps are exactly the same, and the ovary and tube that are kept are handled as little as possible.
Fertility-sparing surgery is not offered for a higher-grade tumour, a clear-cell tumour or spread beyond one ovary. Dr Swati Shah explains what is being kept, what is being risked, and how follow-up will be done, with the woman and her family, before anything is decided.
The cancer operation is the same in all three: the same organs removed, the same biopsies, the same lymph nodes. What differs is how much of the abdomen can be reached, how the deep nodes are cleared, and how quickly a woman is back on her feet.
| Open | Keyhole (laparoscopic) | Robotic | |
|---|---|---|---|
| Incision | A long cut down the middle of the abdomen | Several small ports | Several small ports |
| Reach across the whole abdomen | Complete — every surface can be seen and handled | Limited for widespread disease | Limited for widespread disease |
| Clearing nodes beside the pelvic vessels and aorta | By hand, with good access | Straight instruments; demanding at depth | Wristed instruments and a steady magnified view at depth |
| Blood loss | Higher | Low | Low |
| Lymph nodes removed | The full staging field | The same field | The same field |
| Hospital stay | Longest | Short | Short |
| Return to work and to daily life | Slowest; the wound limits lifting | Faster | Faster; similar to keyhole |
| Starting chemotherapy, when needed | After the wound has healed | Rarely held up by the wound | Rarely held up by the wound |
| Time in theatre | Shortest | Longer | Longest |
| Cost | Lowest | Moderate | Highest |
| Suited to | Advanced spread, a bulky mass, bowel or upper-abdominal surgery, HIPEC | Early disease in selected patients | Early disease, deep node clearance, fertility-sparing surgery |
Keyhole surgery does the same staging well in suitable women. The robot’s advantage is greatest where the work is deepest — the nodes along the aorta and the pelvic side walls — and in a heavier patient. Dr Swati Shah explains where your own case sits when she recommends the approach.
Open surgery is chosen when the cancer has spread across the abdomen, because the aim then is to leave no visible disease anywhere. That may mean stripping the diaphragm, removing a segment of bowel, the spleen or part of the pancreas, and sometimes adding heated chemotherapy inside the abdomen (HIPEC).
An operation that leaves visible disease behind exposes a woman to all of the risks and very little of the benefit. So if, once the abdomen is open, complete removal proves impossible, tissue is taken, the operation is stopped, and chemotherapy is given first, with an operation planned afterwards. When chemotherapy comes first, the later operation — the interval operation — aims for the same complete removal, and that is the setting in which HIPEC is offered here.
Open surgery is also chosen when the mass is too large to remove whole through a small opening, when there have been several earlier operations, or when heart or lung disease makes the head-down tilt and gas pressure of robotic surgery unwise. If, during a robotic operation, the plan has to change, it changes to open, as consented beforehand. That is judgement in the patient’s interest, not a failure.
Recovery follows an enhanced-recovery pathway: sitting out of bed the same evening, sips of fluid the same day, a liquid diet and walking from the next day, and the urinary catheter out early. Most women go home once they are eating, walking and comfortable on tablets.
Ovarian cancer carries a high risk of clots in the legs and lungs, so injections to prevent clots continue for four weeks after discharge, and the family is taught to give them. If both ovaries have been removed, menopause begins at once; it is a certainty, not a complication, and hormone treatment can be discussed for most women with this type of cancer.
The warning signs after surgery are fixed: fever, a fast pulse, new or worsening abdominal pain, breathlessness, a swollen calf, or watery discharge from the vagina weeks later. Any of these means calling the team the same day.
The histology report is gone through at about two weeks. The stage it confirms decides whether chemotherapy is needed, and the genetic result on BRCA and HRD, sent at diagnosis, decides any maintenance treatment afterwards. Follow-up then continues at regular visits with examination and CA-125.
★★★★★
“I am very thankful to Dr. Swati Shah for treating and operating on my mother for ovarian cancer. From the first consultation to the surgery and follow-up, she was very supportive, caring, and explained everything clearly. We felt confident and comfortable under her care. The surgery went well, and my mother is recovering nicely. We are truly grateful for her expertise and dedication. Highly recommended for ovarian cancer treatment and surgery in Ahmedabad.”
★★★★★
“We are extremely grateful to Dr. Swati Shah for treating my mother for ovarian cancer and performing her surgery. She is a very experienced, compassionate, and dedicated doctor. She explained the treatment and surgery very patiently and gave us confidence throughout the entire journey. The surgery went well, and my mother is doing much better now. Thank you, Dr. Swati Shah, for your excellent care and support. Highly recommended for ovarian cancer treatment.”
★★★★★
“Dr. Swati Shah is a very caring, supportive, and knowledgeable doctor. I consulted her regarding an ovarian tumor, and throughout the treatment she explained everything clearly and patiently. Her approach gave me a lot of confidence and reassurance during a difficult time.”
Unedited Google reviews from patients and families treated by Dr Swati Shah for ovarian cancer and ovarian tumours, quoted exactly as written, and a patient speaking after her operation.
Sonal Soni · Google review
Jay Udasi · Google review
RAHUL SOLANKI · Google review
Watch Dr Swati Shah’s video: how robotic ovarian cancer surgery is done (YouTube, Hindi).
Robotic staging surgery costs more than an open or keyhole operation, because of the robotic instruments used in each case and the longer theatre time. The office prepares a written estimate before admission, once the plan is known.
What moves the estimate is the extent of the operation — whether the nodes along the aorta are removed, whether the plan changes during surgery — and the length of stay. Cashless admission is arranged at Apollo Hospital, Bhat where your policy allows it, and the pre-authorisation paperwork is prepared by the office. Ask whether your policy covers robotic surgery and up to what limit, and whether chemotherapy and maintenance tablets are covered separately. Bring the policy documents, photo identity, all reports with the CT on disc, and a list of current medicines.
No. Cancer that appears confined to the ovary or pelvis can usually be staged robotically. Cancer that has spread across the abdomen needs an open operation, because the aim is to leave no visible disease anywhere.
It should not be. The same organs, biopsies and lymph nodes are removed. If the robotic view shows more disease than expected, the plan changes, and that possibility is explained before consent.
If both ovaries are removed, yes — at once and permanently. In carefully chosen young women with the earliest stage, one ovary and the womb can be kept. Hormone treatment after surgical menopause can be discussed for most women with this type of cancer.
That depends on the final stage and the type of tumour on the histology report. Some early cancers need no chemotherapy; others do. The decision is made with the medical oncologist once the report is back.
Most women go home within a few days, once they are eating, walking and comfortable on tablets. Light daily activity resumes within a couple of weeks; heavy lifting waits a little longer.
When the cancer cannot be removed completely at the start, chemotherapy is given first to shrink it. The operation that follows aims to leave no visible disease; its approach is chosen for the disease that remains, and HIPEC may be added at that operation.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
Consultation, review of scans and pathology reports, second opinions, follow-up and surveillance.
Google: 4.9 · 53 reviews
Apollo Hospital — Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
Google: 5.0 · 25 reviews
Women travel for ovarian cancer surgery from across Gujarat, southern Rajasthan and western Madhya Pradesh.
More on ovarian cancer surgery at this centre: Ovarian cancer surgery in Ahmedabad · Gynaecological cancer surgery at this centre · Robotic cancer surgery at this centre · Ovarian cancer explained
Send the CT report, CA-125 and any ultrasound or operation notes ahead of your appointment, so the consultation starts with them already read. Whether your operation can be done robotically is decided at the consultation after examination, and by the tumour board. Call +91-63590-11009 WhatsApp the office
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