Endometrial Cancer Surgery (Laparoscopic Staging)

Medically reviewed by Dr Manan Boob, MBBS (KEM), MS ObGyn (Gold Medalist), DNB — Consultant Gynaecologist & Laparoscopic Surgeon

What it is

Endometrial cancer is cancer of the lining of the womb. The standard treatment for most women is an operation called laparoscopic staging: a total laparoscopic hysterectomy (TLH) with bilateral salpingo-oophorectomy (BSO), meaning the uterus, cervix, both fallopian tubes and both ovaries are removed through small keyhole cuts. Depending on the type and grade of the cancer, some lymph nodes in the pelvis may also be checked or removed (lymphadenectomy).

The word “staging” matters. The operation does two jobs at once. It removes the cancer, and it lets us find out exactly how far the disease has spread, which cannot be judged reliably from scans alone. That information decides whether you need anything further after surgery.

If you want to understand the warning signs that usually bring women in, we have written about them in endometrial cancer: the warning signs women dismiss.

Who needs it

This operation is recommended when a biopsy of the womb lining, usually taken at the time of a hysteroscopy or in the clinic, has shown endometrial cancer, and scans suggest the disease is in the womb or close to it. Most of the women I operate on first came to us with bleeding after menopause, or with heavy, irregular bleeding in the years before it.

Keyhole surgery is suitable for most of these women. It may not be the right choice if the tumour is very large, if the scans show spread outside the pelvis, or if your general health makes a long period under anaesthesia risky. In those situations we plan an open operation or a different route. Our wider gynecologic oncology service works that out with you case by case.

“I’m scared. Does this mean the cancer has already spread?” Not necessarily, and I’d rather give you the honest picture than a vague reassurance. Because bleeding tends to be an early signal, many women are diagnosed while the disease is still limited to the womb. We will not know for certain until the tissue has been examined after surgery. That is exactly why we do the staging properly.

How it is done

You come in fasting, usually the morning of surgery, and the anaesthetist puts you to sleep.

A small cut is made near the navel and the abdomen is gently filled with carbon dioxide gas to make working space. The telescope goes in, followed by three or four slim instruments through other tiny cuts.

First, we look at everything: the womb, tubes, ovaries, bowel surface, liver surface and the lining of the abdomen. Any fluid in the pelvis is collected and sent for examination.

The uterus is then separated step by step. The blood supply is sealed, the tubes and ovaries are released, and the uterus and cervix are detached from the top of the vagina. We use a protective technique so the womb is removed without the tumour being spilled or crushed inside the abdomen.

Depending on the case, lymph nodes in the pelvis may be checked or removed. Some surgeons use a dye to find the key “sentinel” node and remove only that. Whether we do this, and how much we do, depends on the cancer’s type and grade and what the scans show.

The specimen comes out through the vagina. The top of the vagina is closed with stitches, the gas is released and the small cuts are closed.

Anaesthesia, duration and hospital stay

The operation is done under general anaesthesia.

Operating time is usually two to three hours, longer if lymph nodes are being removed or if the anatomy is difficult, for instance after earlier surgery.

Most women stay two to four days in hospital. You will be sitting up the same evening and walking the next morning, which helps recovery and lowers the risk of clots in the legs.

Recovery

Day 1. Soreness at the cuts, a bloated feeling and a dull shoulder ache from the gas. A catheter is usually taken out within a day. Sips of fluid, then light food.

The first week. Short walks around the house, mild tiredness, light vaginal spotting. Showers are fine, with the dressings kept dry. Pain tablets are rarely needed beyond the first few days.

Weeks 2 to 4. Daily routine returns step by step. Avoid heavy lifting, strenuous exercise and anything that strains the lower abdomen. Nothing should be inserted into the vagina and intercourse should wait until the surgeon says the top of the vagina has healed, usually around six to eight weeks.

By six weeks. Most women are back to normal routines. We review you with the final biopsy report well before this, usually within a week or two of surgery, and plan follow-up from there. Because the ovaries are removed, women who were not yet menopausal will enter menopause after surgery. We talk this through beforehand and help with symptoms afterwards.

Call us sooner for fever, heavy bleeding, spreading redness or discharge at a cut, calf pain or swelling, breathlessness, or persistent vomiting.

Why keyhole rather than open surgery

For endometrial cancer, keyhole surgery is well established and is our usual choice when it is safe for the patient. The cuts are tiny, there is less pain, less blood loss, a shorter hospital stay and a faster return to normal life than after an open operation. For women with other health problems, such as diabetes or higher body weight, which are common in this condition, avoiding a large abdominal wound can make a real difference to healing.

But I do not claim it is always better. If the tumour is bulky, the disease has spread, or keyhole access is not safe, the right operation is an open one. We choose the approach that clears the disease safely first, and then do everything we can to make recovery comfortable.

Risks and complications

Cancer surgery is major surgery, and you should hear the risks plainly.

• Bleeding during or after the operation, occasionally needing a transfusion.
• Infection at a cut, in the pelvis or in the urine.
• Injury to the bladder, ureter (the tube from the kidney) or bowel, uncommon, and usually noticed and repaired at the time.
• Blood clots in the legs or lungs. We reduce this with early walking, stockings and, where needed, blood thinners.
• Lymphoedema (leg swelling) and lymphocele, which can follow removal of lymph nodes. Checking fewer nodes lowers this risk.
• Healing problems at the top of the vagina, uncommon.
• Early menopause, in women who were still having periods, because the ovaries are removed.
• Conversion to open surgery if the operation cannot be completed safely through the keyhole.
• Anaesthetic risks, which the anaesthetist will discuss with you separately.

Alternatives

Open (abdominal) surgery achieves the same goal through a larger cut. It is the right choice for some tumours and some patients.

Fertility-sparing treatment, with hormonal therapy and close monitoring, is possible only in carefully selected young women with very early, low-grade disease who strongly wish to have children. It is not a standard alternative, and it carries risks of its own, so it needs a detailed discussion with the specialists.

Radiotherapy or other non-surgical treatment is used when surgery is not possible because of other health conditions, or in addition to surgery depending on the final report. It is planned with the oncology team.

Surgery is not a decision to be hurried, but it is also not one to delay without reason. A few days spent on the right tests lets us choose the correct operation the first time.

What it costs

Endometrial cancer surgery (laparoscopic staging: TLH + BSO ± lymphadenectomy) at Shubham Hi-Tech Hospital: ₹75,000 – ₹1,25,000. This is an all-inclusive figure — surgeon’s fee, operation theatre, anaesthesia, room rent for a typical stay, medicines and routine investigations.

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your surgery

• Bring every report: the biopsy, ultrasound, MRI or CT if done, blood tests, and a list of your medicines.
• Tell us about diabetes, high blood pressure, thyroid or heart problems, and any blood thinners. Some medicines need adjusting beforehand; please do not stop anything on your own.
• Mention any earlier abdominal operations, as these can change the plan.
• Nothing to eat for six hours and nothing to drink for two hours before surgery, unless told otherwise. You may be asked to take a bowel preparation the day before.
• Leave jewellery, nail polish and contact lenses at home.
• Arrange for an attendant to stay with you and for help at home for the first couple of weeks.
• Bring someone you trust to the consultation. It is hard to take everything in alone.

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If you or someone in your family has been told there is a problem with the womb lining, bring the reports and let us go through them together, unhurried. The gynaecology and laparoscopy team at Shubham Hi-Tech Hospital, Amravati, will explain what the diagnosis means and which operation is right for you. Call +91-8668954915 or get in touch here, or see all the procedures we perform.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.