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For cancer of the lining of the uterus, keyhole surgery is the preferred route, not a compromise. This page explains what the robot adds to that operation, how the first lymph node on each side is found and checked instead of clearing them all, and when the operation is still done open. Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad.
Last updated: 8 October 2026
Shah’s Gastro, Cancer & Robotic Surgery Centre. Dr Swati Shah is a surgical oncologist with 18 years of experience, and operates on cancers of the uterus, cervix and ovary by robotic, keyhole and open surgery. Every endometrial cancer is discussed at the tumour board before the operation, and again when the final report and the molecular result are back.
Endometrial cancer is treated first by removing the uterus, the cervix, both tubes and both ovaries. Done by keyhole — robotic or laparoscopic — that operation gives the same cancer results as open surgery with far less strain on the body, which is why it is the preferred route here.
The robot gives a steady, magnified view deep in the pelvis and instruments that bend like a wrist, which helps most when weight, diabetes or heart trouble make open surgery harder to recover from. Its near-infrared camera shows a green dye travelling to the first lymph node on each side.
Those first nodes — the sentinel nodes — are removed and examined in fine detail instead of clearing every node in the pelvis. The uterus comes out whole through the vagina in a bag, and most women go home the same day or the next.
Almost every woman whose cancer appears confined to the uterus is a candidate for keyhole surgery, robotic or laparoscopic. The benefit is greatest for women who are heavier or who have diabetes, high blood pressure or heart disease — the women for whom a large abdominal cut is hardest to recover from.
Endometrial cancer and cervical cancer are different diseases with opposite evidence. In cervical cancer, keyhole radical surgery has fallen out of favour. In endometrial cancer the opposite holds: large trials found the same cancer outcomes with keyhole surgery and fewer complications. A woman who has heard that “cancer of the womb must be operated open” has usually heard the cervical-cancer rule applied to the wrong disease.
Some situations still call for a different route. A very large uterus that cannot be brought out whole through the vagina, dense scarring from earlier operations, or disease that has clearly spread beyond the uterus and needs a wider removal, point to open surgery. A woman who is genuinely unfit for any abdominal operation may be offered removal of the uterus through the vagina alone, accepting that the staging is incomplete, after a tumour-board discussion.
How endometrial cancer is suspected and confirmed is covered on the robotic uterus cancer surgery page and at the consultation. This page is about the operation and what the robot changes in it.
A young woman with a low-grade cancer who still wishes to have children may be suitable for hormone treatment instead of surgery for a time. That is a separate, narrow path, discussed in person and not covered here.
The operation itself is the same whichever keyhole method is used. The robot adds a magnified, three-dimensional view held steady deep in the pelvis, wristed instruments that work around the uterus and along the pelvic side walls, and a near-infrared camera that shows the dye marking the sentinel nodes.
The pelvis is narrow, and the vessels to the uterus run close to the tubes that carry urine from the kidneys. A steady, magnified view lets Dr Swati Shah follow those tubes and seal the vessels precisely. Wristed instruments reach around the uterus and into the corners of the pelvis without the awkward angles of straight keyhole instruments.
Weight changes keyhole surgery more than most people expect. In a heavier woman the abdominal wall is thick and the bowel crowds the pelvis; the robot’s arms hold their position against that weight, so the operation proceeds without constant readjustment. This is one reason the robot is useful in exactly the women who benefit most from avoiding an open cut.
Keyhole and robotic surgery reach the same oncological result in this disease. The choice between them is made at the consultation, according to the woman’s build, her other illnesses and the size of the uterus. There is no sense of touch through the robot’s instruments, so findings are judged by sight and by the imaging done before the operation.
The woman lies on her back with her legs supported and the table tilted head-down, so the bowel moves up out of the pelvis. A camera port is placed near the navel and robotic ports across the abdomen, and the robot is docked once positioning and padding are complete.
The head-down tilt is what makes room to work in the pelvis. Breathing and blood pressure are watched closely in this position, which is one reason the anaesthetic assessment is booked early for women with heart or lung trouble, sleep apnoea or diabetes.
The first step is a look around the abdomen — the lining, the fatty apron, the surface of the liver and the ovaries — and a sample of fluid washed from the pelvis is sent to the laboratory. If disease is found where the scans did not show it, the plan is reconsidered on the table rather than followed by rote.
A green dye is injected into the cervix at the start of the operation. It travels along the lymph channels to the first lymph node on each side of the pelvis — the sentinel node — which glows under the robot’s near-infrared camera. That node is removed and examined in fine detail.
Cancer that spreads from the uterus reaches the sentinel node first. If that node is clear, the others are very unlikely to be involved, so they are left in place. Removing every node in the pelvis, the older approach, did not help women live longer and caused far more leg swelling.
The pathologist is asked, by name, to ultrastage the sentinel nodes — to cut them very thinly and stain them for tiny deposits that a routine examination can miss. This request is not automatic, and it is written on the form.
Sometimes the dye does not reach a node on one side. An unmapped side is an unstaged side, so the lymph nodes on that side of the pelvis are removed in the usual way. Any node that looks enlarged or suspicious is removed whatever the dye shows.
For high-grade or serous cancers, nodes higher up along the main blood vessels may also be removed, when the result will change the treatment that follows. Where the dye and near-infrared imaging are not available, nodes are removed in the older way with consent for the higher chance of leg swelling — nodal assessment is never simply left out.
The uterus, the cervix, both fallopian tubes and both ovaries are removed together. The blood vessels to the uterus are sealed, the bladder is eased away and the ureters are kept in view, and the uterus is taken out whole through the vagina in a bag before the top of the vagina is closed.
For serous cancers and carcinosarcoma, which behave more aggressively, the fatty apron and samples of the abdominal lining are removed as well, because these cancers can seed there even when they look confined.
The uterus is never cut into pieces inside the body to remove it, every lymph node in the pelvis is not cleared as a routine, and a frozen section during the operation is not used to decide how much staging to do. Each of these is avoided for a reason.
Cutting the uterus up inside the abdomen — morcellation — could scatter cancer cells, so in known or suspected cancer it is never done. That is why the size of the uterus matters: if it cannot come out whole through the vagina, the operation is planned differently.
A full clearance of pelvic nodes adds leg swelling and fluid collections without helping survival, which is why the sentinel approach replaced it. A frozen section during the operation is unreliable for judging the grade of an endometrial cancer, so the staging plan is set before the operation, not changed on a quick reading.
The operation is done open, or changed to open, for a very large uterus, dense adhesions from earlier surgery, or whenever a safe keyhole operation is not achievable. Disease that has spread through the abdomen and can be removed completely is operated open. A change to open is consented in advance and is a good decision, not a failure.
If disease is found beyond the uterus that the scans did not predict, the plan is reassessed during the operation. Sometimes that means a wider removal; sometimes it means taking samples and stopping, so that treatment can be planned properly. Either way the family is told what was found and why the plan changed.
All three remove the same organs with the same sentinel-node staging, and keyhole and robotic surgery give the same cancer results as open surgery. They differ in the size of the cut, in blood loss, in how quickly a woman goes home and back to work, and in which situations each suits.
| Open | Keyhole (laparoscopic) | Robotic | |
|---|---|---|---|
| Incision | A cut on the lower abdomen | Small ports; the uterus comes out through the vagina | Small ports; the uterus comes out through the vagina |
| View deep in the pelvis | Direct | Magnified, flat | Magnified, three-dimensional, held steady |
| Sentinel-node mapping | Possible with a separate imaging system | Possible with a near-infrared camera | Near-infrared camera built in |
| Blood loss | Higher | Lower | Lower |
| Lymph nodes | Sentinel nodes, or side-specific removal | The same | The same |
| Hospital stay | A few days | Same day or next day | Same day or next day |
| Return to work | Slowest | Quicker | Quicker |
| Cost | Lowest | Similar to open | Higher, for the robotic instruments |
| Suited to | Very large uterus, dense adhesions, spread needing wider removal | Most women with disease confined to the uterus | Most women with disease confined to the uterus, including heavier women |
The certainty of menopause after removal of the ovaries, the chance of leg swelling, and the decision about treatment after surgery are the same whichever route is used.
After uncomplicated robotic surgery, women sit out of bed within hours, eat and drink the same day, have the urinary catheter removed that evening, and go home the same day or the next morning. Walking starts the same day.
Before going home, the family is taught the warning signs: fever, a foul-smelling discharge, pain that is worsening rather than easing, breathlessness or calf pain. Blood-thinning injections are given and taught, because pelvic cancer surgery raises the risk of clots, especially with extra weight.
The top of the vagina heals over several weeks. Sudden bleeding or a feeling of something coming down, especially after intercourse, needs urgent attention, so intercourse waits until healing is confirmed at follow-up. Any swelling of one leg is reported early — a scan first to exclude a clot, then early compression if it is lymph swelling.
Removing the ovaries brings menopause the day after surgery, with hot flushes for some women. For low-risk early cancers, hormone replacement is usually acceptable and is discussed rather than silently withheld. When to return to work and to lifting is planned with you at the follow-up visit, according to how the wound and the vault are healing.
The final report and the molecular tests on the tumour are reviewed together about two weeks after surgery, and that visit decides whether any further treatment is needed. The appointment is booked before you leave hospital.
The molecular tests now matter as much as the grade. Some tumours carry a change that means no further treatment is needed; others behave more aggressively and need chemotherapy or radiotherapy even when small. That is why the plan waits for the result rather than being made on the first report alone.
The report records both the current and the older form of staging, because many hospitals and insurers still use the older one. Where the tumour shows a particular pattern on testing, Lynch syndrome is looked for; it can matter for a woman’s children and siblings, and the referral is tracked to completion.
Follow-up visits are every three to four months for the first two years, then six-monthly. Each includes an examination of the vaginal vault and direct questions about bleeding, leg swelling, menopausal symptoms and sexual health. Routine scans are not needed for low-risk disease.
★★★★★
“Doctor Swati shah operated my mother for endometrium cancer .we came after 3 yrs . Now she is good . Thank u so much mam.”
★★★★★
“Great experience with dr. Swati madam and staff”
★★★★★
“My mother was treated for cervix cancer 5 years ago by Dr. Swati Shah (Gynec Oncologist). She is highly skilled, explains everything clearly, and provides very compassionate care. Thanks to her expertise, my mother is doing well today. Highly recommended.”
Unedited Google reviews from families of women treated by Dr Swati Shah for endometrial and cervical cancer, quoted exactly as written, and a patient speaking after robotic surgery for uterus cancer.
Bharat Algotar · Google review
bharat chavda · Google review
Meena Yadav · Google review
Watch Dr Swati Shah’s video: why the sentinel lymph node matters in uterus cancer (YouTube).
Robotic surgery for endometrial cancer costs more than keyhole or open surgery, because of the robotic instruments. Removal of higher lymph nodes, a wider operation for spread disease or a longer stay change the total. The office prepares a written estimate once the route is decided.
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 it covers molecular testing of the tumour. Bring the policy documents, photo identity, every report with the scans on disc, and a list of current medicines.
Yes. For cancer confined to the uterus, keyhole surgery — robotic or laparoscopic — is the preferred route. Open surgery is kept for a very large uterus, dense adhesions or wider spread.
Yes. They are different diseases. For endometrial cancer, trials found the same cancer results with keyhole surgery and fewer complications.
The first lymph node that drains the uterus on each side. A green dye shows it on the robot's camera; it is removed and examined in fine detail instead of clearing all the nodes.
Not routinely. Only the sentinel nodes, any suspicious node, and the nodes on a side where the dye did not show a sentinel node. Higher nodes are removed for some aggressive cancers.
No. It is removed whole through the vagina in a bag. If it is too large for that, the operation is planned differently.
Usually the same day or the next morning after uncomplicated robotic surgery, once you are eating, walking and passing urine.
Shah’s Gastro, Cancer & Robotic Surgery Centre — Gota, Ahmedabad
Consultation, review of scans and pathology reports, second opinions, follow-up and surveillance.
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Apollo Hospital — Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
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Women travel for endometrial cancer surgery from across Gujarat, southern Rajasthan and western Madhya Pradesh.
Send the biopsy report, the MRI report and any CT or blood reports ahead of your appointment, so the consultation starts with them already read. Whether your operation is robotic, keyhole or open is decided at the consultation after examination, and by the tumour board. Call +91-89800-20898 WhatsApp the office
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