Invasive surgery is no longer the only treatment option for some complex gynecological cancers.
Dr. Michael Worley Jr., a board-certified gynecologic oncologist with Jupiter Medical Center’s Anderson Family Cancer Institute, said most facilities that perform minimally invasive robotic surgery limit their offerings to endometrial (uterine) cancer, the most common of the five main gynecological cancers.
“Ovarian surgeries can be complex,” Worley says, adding they are often performed with an open incision. However, “they can be offered robotically if the surgeon has advanced skills and knowledge.”
Worley was recruited by JMC for his expertise in ovarian cancer and hyperthermic intraperitoneal chemotherapy (HIPEC) from Brigham and Women's Hospital in Boston, where he established the first HIPEC protocol as the director of ovarian cancer surgery at Dana-Farber Brigham Cancer Center. “There is a smaller niche of experts in that field,” Worley says.
According to a study published January 2025 in the European Journal of Surgical Oncology, robotic surgery for gynecological cancers is much more than a technological advancement. The study describes it as “a paradigm shift” that has ushered in “an era of minimally invasive approaches to complex oncological procedures, offering a compelling blend of precision, visualization, and ergonomic advantages that directly translate into improved patient outcomes.”
For most women, Worley says, the standard of care for endometrial cancer is a hysterectomy and lymph node evaluation. “Because of the advances, just five to six years ago, the robotic platform evolved to allow the evaluation of lymph nodes that is very different from 10 to 15 years ago,” he says. “It uses dye to evaluate the lymph nodes, so you take fewer lymph nodes.”
Robotic vessel-sealing devices have also gotten smaller over the last few years, causing less trauma to the tissue, Worley says. The latest version of the robotic platform has haptic—or tactile—feedback. Because the surgeon has the sensation of touching tissue, he says, “it allows us to offer more complex procedures.”
When such complex procedures are done through minimally invasive robotic surgery, Worley says, there is a long list of benefits for the patients, including:
“Recovery takes a couple of days to a couple of weeks to get back to normal activity,” reports Worley, who also treats uterine, cervical, and vulvar cancers.
A 2024 study in the Journal of Robotic Surgery reports that by significantly reducing pain, robotic surgery reduces the need for painkillers: “Prolonged hospital stay, complications and pain are undesirable situations in the postoperative period. The solution of robotic surgery in these areas can increase the quality of nursing care and patient satisfaction.”
When patients meet Worley, they often expect open surgery because their referring physician or OB-GYN is familiar with that approach. Or a family member sets that expectation because they had the surgery years ago. He then explains minimally invasive options. “This is the new standard. It’s not experimental,” Worley says. “Lots of things change in 20 years—phones, TVs, medicine. Why would this be anything different?”
An additional step during surgery for advanced-stage ovarian cancer can significantly reduce the chance of the cancer coming back. Called hyperthermic intraperitoneal chemotherapy (HIPEC), it’s the distribution of heated chemotherapy within the abdominal cavity where the disease was removed. It is done in combination with the standard treatment of surgery and six courses of chemotherapy.
Dr. Michael Worley Jr. established the first HIPEC protocol for ovarian cancer at Brigham and Women's Hospital before coming to Jupiter Medical Center. “Brigham had a HIPEC program for thoracic surgery. They didn’t have it for ovarian,” he says. “Studies were starting to show it was a good option for patients, that they live longer.”
According to a 2022 study published in the European Society for Medical Oncology, HIPEC can significantly improve survival, reducing the risk of death by 23 percent at five years when compared with no HIPEC treatment.
Worley explains the process of treating the abdominal cavity with a gardening metaphor. “Once you pull all the weeds out, then you put a barrier down to prevent them from coming back in the same location, and you also treat the entire yard,” he says.
Although the data is strong, HIPEC is not for everyone. Good candidates have a new diagnosis of stage 3 ovarian cancer or have recurrent ovarian cancer that is confined to the abdominal cavity. “With HIPEC, they’ll live longer and it’s less likely to recur,” Worley says. “It’s not just an option—it’s a good option for patients.”