Duke Health’s gynecologic oncology and minimally invasive gynecology surgeons have extensive experience performing complex procedures using advanced minimally invasive surgical (MIS) techniques, including robotics. 

Surgery is a common treatment for many gynecologic conditions, including fibroids, abnormal bleeding, and cancer. For gynecologic cancers such as uterine cancer, surgery is usually the first and primary treatment, says Emma Rossi, MD, gynecologic oncologist. 

According to Rossi, a MIS approach, whether laparoscopic, vaginal or robotic-assisted, is often the best option for patients with a gynecologic condition requiring surgery. Extensive research indicates that procedures like minimally invasive hysterectomies provide better outcomes, a shorter length of stay, and lower infection rates. For oncology patients, quicker recovery from MIS can help prevent delays in adjuvant treatment when necessary.

Robotic-assisted surgery is one of the minimally invasive options available at Duke Health. This approach provides improved visualization and precision, which is especially helpful for complex anatomy or oncologic dissections. Rossi adds that any patient who needs gynecologic oncology surgery or has another complex gynecologic condition can be considered for a robotic-assisted approach. “Women facing a gynecologic diagnosis want two things: to effectively treat their condition and get back to their lives as quickly as possible,” she says. “Robotic-assisted surgery helps make that possible.”

Rossi is a nationally recognized expert in robotic-assisted surgery for gynecologic cancers. She recently became the lead principal investigator for Embrace Gynecology, a national multicenter clinical trial testing a state-of-the-art robotic system for gynecologic procedures, including cancer surgeries. 

Embrace Gynecology is enrolling up to 70 patients across five U.S. hospitals in the next few months. Rossi says trials like this are important because they will expand minimally invasive surgical options for women. 

Duke is one of only a few national sites participating in this trial, reflecting the expertise of its gynecologic oncology surgical program. Participation in this trial gives eligible patients access to next-generation robotic platforms not widely available in the region.

Common indications for referral include:

• Fibroids
• Endometriosis
• Ovarian masses
• Prior pelvic adhesive disease (scar tissue)
• Early-stage gynecologic cancer

Two conditions should always prompt referral for evaluation of a MIS approach:

• Hysterectomy: All patients needing a hysterectomy (for benign or malignant indications) should be considered for a minimally invasive or vaginal approach, with or without robotic assistance.
• Gynecologic cancer: All patients requiring surgery for gynecologic cancer should be referred to a gynecologic oncology subspecialist. Rossi notes that outcomes are superior when surgery is performed by surgeons specifically trained in gynecologic cancer care.

“Geography should not prevent patients from having access to the best possible outcomes,” she says. To address this need, Duke Health’s gynecologic oncology and gynecologic surgeons see patients at multiple locations across the Triangle area. 

For gynecologic oncology referrals, the team’s policy is to see patients within 48 hours. “Regardless of diagnosis, patients shouldn’t have to wait longer than that to get access to the subspecialty care offered at Duke that may have a big impact on their outcome trajectory,” Rossi says. 

The Duke Division of Minimally Invasive Gynecology (MIGs) includes expertise in all MIS modalities, including laparoscopy and robotic-assisted surgery. This expertise means they can work with the patient and their referring provider to determine the approach best suited to each patient’s anatomy, diagnosis and overall clinical needs.