Comprehensive surgical management of all gynaecological cancers — radical hysterectomy, cytoreductive surgery with HIPEC, robotic pelvic surgery, sentinel lymph node mapping, and fertility-sparing procedures — with a focus on cure, function, and quality of life.
Gynaecological cancers — arising from the cervix, uterus, ovaries, vulva, and vagina — are among the most common cancers in Indian women. Surgery is the cornerstone of treatment for most early and locally advanced gynaecological cancers, with the extent of resection determined by the cancer type, stage, and the patient's goals regarding fertility and function.
Dr. Gore's training in Gynaecological Oncology at Tata Memorial Hospital, Mumbai — India's premier cancer centre — provided comprehensive exposure to the full spectrum of gynaecological cancer surgery, including radical hysterectomy, pelvic and para-aortic lymphadenectomy, cytoreductive surgery for ovarian cancer, and reconstructive procedures. This training, combined with his FARIS robotic surgery credentials, enables him to offer the complete range of open, laparoscopic, and robotic approaches.
A key feature of his practice is the routine use of ICG fluorescence for sentinel lymph node (SLN) mapping in endometrial cancer — a technique that allows precise, bilateral nodal staging while avoiding complete pelvic lymphadenectomy in appropriate patients, significantly reducing the risk of lymphoedema.
Gynaecological cancer surgery requires a particularly nuanced approach — because the patients are often young women, and the outcomes affect not just survival but fertility, continence, sexual function, and body image. I take these dimensions very seriously.
For cervical cancer, the decision between trachelectomy (fertility-sparing) and radical hysterectomy is one I discuss carefully with every young patient. For ovarian cancer, the goal of complete cytoreduction — CC0 with no visible residual disease — is what determines survival, and I plan every operation with that as the primary objective.
Robotic radical hysterectomy for endometrial cancer has become my preferred approach — the magnified 3D pelvic view and wristed instruments make precise ureteral and neurovascular dissection far superior to open surgery, with dramatically faster recovery for patients.
— Dr. Vinod T. Gore, MBBS MS FAIS FIAGES FARIS (Edin)All gynaecological malignancies treated with surgery-led, multidisciplinary care — from early-stage fertility-sparing procedures to complex cytoreductive operations.
Squamous cell carcinoma and adenocarcinoma of the cervix — most common gynaecological cancer in India. Radical hysterectomy, trachelectomy, chemoradiation
Most CommonUterine cancer — most common in postmenopausal women. Robotic hysterectomy with ICG sentinel lymph node mapping. Excellent prognosis when caught early
Very CommonEpithelial ovarian cancer — most lethal gynaecological cancer. Cytoreductive surgery (debulking) + HIPEC, neoadjuvant chemotherapy, staging laparotomy
High MortalitySquamous cell carcinoma of the vulva — wide local excision, radical vulvectomy, sentinel node biopsy, inguinal lymphadenectomy
Less CommonIndia has one of the world's highest burdens of cervical cancer. Surgery is the treatment of choice for early-stage disease — with the choice of procedure determined by stage, tumour size, and fertility wishes.
Cervical cancer surgery involves removal of the cervix, uterus, parametria (the tissue alongside the cervix), and an upper vaginal cuff — along with pelvic lymph node dissection to assess nodal status. The extent of the "radical" component (Piver-Rutledge classification, Type I–V) depends on the stage and tumour size.
For early-stage disease (Stage IA–IB1), surgery is the primary treatment — offering excellent cure rates with the advantage of ovarian preservation in young women (avoiding premature menopause, unlike radiotherapy). For locally advanced disease (Stage IB3–IIB), concurrent chemoradiotherapy (Cisplatin + radiation) is the standard — with surgery used for specific indications or recurrent disease.
Critically, every young woman with early cervical cancer should have the option of radical trachelectomy — a fertility-preserving procedure that removes the cervix while leaving the uterus intact, allowing future pregnancy. This is discussed at the first consultation before surgery is planned.
Fertility-sparing removal of the cervix — leaving the uterus intact for future pregnancy. Appropriate for Stage IA2–IB1 tumours ≤ 2cm in young women who wish to preserve fertility.
Fertility PreservingComplete removal of the uterus, cervix, upper vagina, parametria, and pelvic lymph nodes — the gold standard for Stage IA2–IB2 cervical cancer. Performed open or robotically.
Standard Surgical TreatmentSystematic bilateral pelvic lymph node dissection (obturator, external iliac, internal iliac, common iliac) — performed with all radical hysterectomies for pathological nodal staging.
Staging Procedureda Vinci robotic approach — superior 3D pelvic vision, precise parametrial dissection, ureteral and bladder preservation, reduced blood loss. Faster recovery than open Wertheim's — discharged in 1–3 days.
Robotic — Preferred ApproachEndometrial cancer presents early — abnormal uterine bleeding in postmenopausal women leads to prompt diagnosis in Stage I in most cases. Surgery is highly curative, and the robotic approach is now the preferred technique.
Complete information on robotic hysterectomy for endometrial cancer — procedure, patient eligibility, ICG sentinel node mapping, recovery, and outcomes by Dr. Vinod T. Gore.
bestroboticsurgeonpune.in/Robotic Radical HysterectomyThe standard surgical treatment for endometrial cancer is Total Hysterectomy with Bilateral Salpingo-Oophorectomy (TH + BSO) — removal of the uterus, both tubes and ovaries. In higher-risk cases, this is combined with pelvic ± para-aortic lymphadenectomy or ICG sentinel lymph node mapping for precise nodal staging.
The robotic approach has become the preferred technique for endometrial cancer surgery — offering superior 3D visualisation in the pelvis, precise dissection around the ureter and bladder, reduced blood loss (<100ml in most cases), and a hospital stay of 1–2 days compared to 5–7 days after open surgery. Patients recover faster and return to adjuvant treatment sooner.
Dr. Gore routinely performs bilateral ICG sentinel lymph node mapping for endometrial cancer — injecting ICG into the cervix, allowing precise identification of the first-echelon lymph nodes without full pelvic lymphadenectomy in appropriate low-intermediate risk patients, reducing lymphoedema risk significantly.
da Vinci robotic hysterectomy with bilateral salpingo-oophorectomy — the preferred approach. 1–2 day hospital stay, minimal blood loss, rapid recovery, superior pelvic dissection.
Bilateral ICG sentinel node mapping (cervical injection) — identifies first-echelon pelvic nodes with high accuracy. Avoids full lymphadenectomy in appropriate cases, preventing lymphoedema.
Systematic bilateral pelvic and para-aortic nodal dissection for high-risk endometrial cancer — serous, clear cell, carcinosarcoma, high-grade endometrioid with deep myometrial invasion.
Based on pathological staging (myometrial invasion, lymph node status, LVSI, grade, histology) — adjuvant radiotherapy (EBRT ± VBT) and/or chemotherapy recommended by tumour board.
POLE, MMR/MSI, p53 status from surgical specimen — guides adjuvant treatment decisions and immunotherapy eligibility in recurrent or advanced disease.
Ovarian cancer is often diagnosed at an advanced stage — with peritoneal spread throughout the abdominal cavity. The goal of surgery is complete cytoreduction — no visible residual disease — which is the single most important determinant of survival.
Ovarian cancer surgery is fundamentally different from other gynaecological cancer operations — it is not simply about removing the ovaries and uterus, but about achieving complete clearance of all peritoneal disease (CC0 — no visible residual tumour). This may require removal of bowel, omentum, peritoneum, diaphragm, spleen, and other structures involved by cancer.
For Stage III–IV ovarian cancer, two surgical approaches are used: Primary Debulking Surgery (PDS) — upfront surgery followed by chemotherapy — or Interval Debulking Surgery (IDS) — neoadjuvant chemotherapy (3 cycles) followed by surgery, then further chemotherapy. The choice depends on tumour biology, patient fitness, and predicted surgical completeness.
In selected patients, HIPEC (Hyperthermic Intraperitoneal Chemotherapy with Cisplatin) is delivered at the time of cytoreductive surgery — the OVHIPEC trial (NEJM 2018) demonstrated improved recurrence-free and overall survival with this approach in Stage III ovarian cancer patients who achieved complete or near-complete cytoreduction.
Cytoreductive Surgery + HIPEC, eligibility, Cisplatin protocol, outcomes — see the HIPEC page
Complete exploration of the abdomen and pelvis — intraoperative PCI (Peritoneal Cancer Index) assessment before proceeding with cytoreduction.
Removal of the uterus, both tubes and ovaries — the core of all ovarian cancer surgery regardless of stage.
Complete removal of the omentum (fatty apron covering the bowel) — ovarian cancer almost universally involves the omentum. "Omental cake" excised en bloc.
Bilateral systematic lymph node dissection — for staging and to maximise tumour clearance in selected cases.
Stripping of tumour-bearing peritoneum from pelvic and abdominal walls, diaphragm. Bowel resection, splenectomy if needed for CC0.
For selected Stage III patients who achieve CC0/CC1 cytoreduction — heated Cisplatin circulated through the abdomen for 90 minutes intraoperatively (OVHIPEC protocol).
Vulvar cancer — most commonly squamous cell carcinoma — requires surgical excision with careful attention to functional and cosmetic outcomes, alongside accurate nodal staging to guide adjuvant treatment.
For small, localised vulvar cancers (T1) — surgical excision with a minimum 1cm tumour-free margin. Preserves normal vulvar anatomy where possible. Performed with or without sentinel lymph node biopsy depending on tumour size and location.
For tumours <2cm with invasion <1mm (Stage IA) — wide local excision alone is curative, without nodal assessment required.
Stage IA–IB SelectedFor unifocal vulvar tumours <4cm with clinically negative nodes — sentinel lymph node biopsy (using ICG ± Technetium-99m) avoids full inguinofemoral lymphadenectomy in node-negative patients, significantly reducing wound complications and lymphoedema.
SLN biopsy has equivalent recurrence outcomes to full lymphadenectomy in appropriately selected patients — a major advance in vulvar cancer surgical management.
Standard for Selected T1–T2For larger or centrally placed vulvar tumours — radical removal of the vulva with bilateral inguinofemoral lymph node dissection. The three-incision technique (separate groin incisions) has replaced en bloc resection — reducing wound complications while maintaining oncological completeness.
Wound closure and reconstruction after radical vulvectomy may require skin grafting or flap reconstruction — Dr. Gore's plastic surgery training is directly relevant here.
Locally Advanced DiseaseThe narrow female pelvis — containing the uterus, bladder, ureters, rectum, and major pelvic vessels in a confined space — is where the limitations of open surgery and the advantages of robotic surgery are most pronounced. The da Vinci system's magnified 3D vision and wristed instruments allow dissection precision in this space that is simply not possible with open surgery or standard laparoscopy.
For endometrial and cervical cancer surgery, the robotic approach allows precise parametrial dissection, ureteral identification and preservation, nerve-sparing hysterectomy (protecting bladder and bowel function), and systematic lymphadenectomy — all with significantly less blood loss and a hospital stay measured in days rather than weeks.
10–15× magnification in the pelvis — identifies ureter, bladder pillars, and parametrial tissue planes with clarity impossible with the naked eye.
Full rotational range in the narrow pelvis — enables parametrial dissection, colpotomy, and pelvic node dissection with precision unachievable by open or lap surgery.
Integrated near-infrared ICG imaging — real-time bilateral sentinel lymph node identification during robotic hysterectomy. No separate procedure needed.
Most patients undergoing robotic radical hysterectomy for endometrial cancer are discharged in 1–2 days — returning to normal life within 2 weeks.
Complete guide to robotic hysterectomy for endometrial cancer — FARIS Edinburgh trained, Best Robotic Oncosurgeon NBT 2024, Sahyadri Manipal Hospitals, Pune.
bestroboticsurgeonpune.in/Robotic Radical HysterectomyBilateral ICG sentinel lymph node (SLN) mapping has replaced full pelvic lymphadenectomy in low-to-intermediate risk endometrial cancer — reducing the risk of lymphoedema while maintaining accurate nodal staging.
In endometrial cancer, lymph node status is one of the most important prognostic factors — determining whether adjuvant radiotherapy or chemotherapy is needed. Traditional management required full bilateral pelvic lymphadenectomy — removing 20–30+ nodes — which carries a significant risk of lower limb lymphoedema (10–20% lifetime risk).
ICG sentinel lymph node mapping — injecting ICG into the cervix at the start of surgery — identifies the first-echelon drainage node(s) in each hemipelvis under near-infrared fluorescence. These nodes are then selectively removed and ultra-staged (step sectioning + IHC). If the SLN is negative, the remaining pelvic nodes are almost certainly negative — avoiding full dissection in appropriate patients.
Dr. Gore performs bilateral ICG SLN mapping routinely during robotic hysterectomy for endometrial cancer — it is now an integral part of his standard surgical approach, guided by the NCCN and ESGO/ESMO guidelines.
ICG 1mg/ml injected superficially and deeply into the cervix at 3 and 9 o'clock positions at the start of robotic surgery.
da Vinci Firefly™ switched to NIR mode — ICG tracks along lymphatics and concentrates in the sentinel node, glowing bright green in real time.
The sentinel node in each hemipelvis is identified and excised. Bilateral mapping achieved in >85% of cases. If unilateral only, systematic side-specific dissection performed.
SLN sent for step serial sectioning and immunohistochemistry — detects micrometastases and isolated tumour cells invisible on standard H&E staining.
Negative predictive value of ICG bilateral SLN mapping for pelvic node metastases in endometrial cancer — when both sides are mapped
For any gynaecological cancer diagnosis — cervical, endometrial, ovarian, or vulvar — book a consultation with Dr. Gore for a complete surgical assessment, staging review, and personalised treatment plan.