University of Gynecologic Oncology » Atlanta Gynecologic Oncology

UGO continues its commitment to provide comprehensive gynecological cancer care for its patients through a multidisciplinary approach. Our state-of-the-art services provide the highest level in prevention, diagnosis, and treatment. Dr. Benedict Benigno is a pioneer in the use of Heated Intraperitoneal Chemotherapy to treat ovarian cancer and remains at the forefront of patient care and technology and treatment. Benigno combines surgical intervention with concentrated chemotherapy and hyperthermia to improve prognosis for patients with metastatic ovarian tumors. This synergistic effect offers an attractive treatment alternative for the ideal patients.

What is HIPEC?

Hyperthermic Intraperitoneal Chemoperfusion is a method of delivering chemotherapy, which has been heated to a degree lethal to cancer cells, directly into the abdomen at the time of surgery. HIPEC has been successfully used in the treatment of cancer of the stomach, colon and appendix for the last 25 years. Since 1994, HIPEC therapy has been applied to the treatment of ovarian cancers within the United States and around the world (3). Like other cancers originating within the abdomen and pelvis, ovarian tumor cells can slip away, circulate around in the peritoneal fluid, and attach to the surface of other organs. Without chemotherapy, these microscopic cancer cells will likely cause recurrent disease.

When is HIPEC given?

During the operative procedure, the uterus, ovaries and fallopian tubes, omentum, appendix, and possibly a sampling of lymph nodes, are removed, as well as any buildup of tumor cells seen in the peritoneal area. Removing of all evidence of tumor is also known as debulking or cytoreductive surgery and gives us information about the type of tumor cells and the extent, or stage, of disease. After the surgery is complete, a concentrated chemotherapy solution is heated and infused into the peritoneal cavity for about 90 minutes. During this time, the patient is gently rocked side-to-side to ensure that the heated chemotherapy solution circulates and spreads throughout the entire abdomen, coming into direct contact with any remaining tumor cells.

Why Heated Chemotherapy

Tumor cells are malfunctioning, defective, rapidly-dividing cells and are very sensitive to higher temperatures compared to stable, healthy cells. Hyperthermic exposure causes tumor cells to die (apoptosis) because they cannot recover from exposure to higher temperatures where normal cells can still escape thermal damage. Normal body temperature is 37 degrees Celsius, or 98.6 degrees Fahrenheit; however, during HIPEC treatment, the chemotherapy solution is heated to 42-43 degrees Celsius (107-109 degrees Fahrenheit) and instilled into the abdomen for approximately 90 minutes. In addition, the heat produces further cancer-fighting activity by allowing chemotherapy to penetrate deeper into the tissue lining the organs and abdominal wall (4, 5, 6).

• www.thermasolutions.com

Who can be treated?

Patients who have been diagnosed for the first time with ovarian cancer from a biopsy of a mass or with a sample of fluid from the abdomen can be considered for HIPEC treatment. On the other hand, it may not be possible to confirm the presence of ovarian cancer until the time of surgery. In this case, if ovarian cancer is suspected prior to surgery, the patient and the medical team will be prepared to initiate HIPEC if ovarian cancer is encountered. A woman with a recurrence of ovarian cancer is also eligible, as well as women whose cancer was originally from the peritoneum or endometrial lining and then spread into the abdomen. Another pelvic cancer treated effectively with HIPEC is pseudomyxoma peritonei, a mucus producing cancer of the appendix. HIPEC candidates should not have any known cancer outside the abdominal cavity.

At UGO our surgeons are committed to advancing the field of surgical techniques within gynecological surgery. Doctors Guilherme Cantuaria and John McBroom are some of the most successful gynecological robotic surgeons in the world. Using the daVinci robotic system, Canatuaria and McBroom are able to provide UGO patients with groundbreaking alternatives to both traditional open surgery and conventional laparoscopy. Our surgeons perform the most complex and delicate procedures through very small incisions with unmatched precision.

What is Robotic Surgery?


Robotic surgery with the daVinci system combines the benefits of laparoscopic surgery with the dexterity of traditional open surgery. This allows a surgeon to perform complex procedures laparoscopically, that would previously have required a large open incision to perform. After the patient is asleep and positioned, laparoscopic ports (small 8mm access holes with sleeves) are placed into the patient's abdomen as in traditional laparoscopy. The daVinci surgical cart is then attached to the ports and specialized laparoscopic instruments are inserted. Unlike traditional laparoscopic instruments which have limited freedom of movement, these instruments are designed like a human wrist, with the ability to bend, rotate, flex,etc. The surgeon controls the movements of these instruments from a console located next to the patient. By manipulating hand grips within the console, the computer translates these movements into movements by the laparoscopic instruments. At no time does the computer "robot" perform any motion on its own - all actions are directly controlled by the surgeon. As an similar example, with some of today's advanced cars, when you press on the gas or brake, you aren't directly controlling a brake lever or throttle, you are telling the car's computer how much you want to press the brake or open the throttle.

Patient Benefits



1. Shorter Hospital Stay
   With traditional open surgery, patients have to stay an average of 3-5 days in the hospital recovering. With robotic laparoscopic surgery, most of our patients are able to go home the next morning.
2. Faster recovery
   After open surgery, most patients require 4-6 weeks before they are back to their normal activities, back to work, etc. After robotic laparoscopic surgery, most are able to return to normal activities within 1-2 weeks.
3. Less pain
   Instead of a large 12-14" incision, most patients only have 4 to 6 small (1/4") incisions. Additionally, because less bleeding and tissue manipulation is required on the inside of the abdomen, there is less pain from this as well. Many patients do not require any narcotic use at all after surgery.
4. Less blood loss and transfusion
   Because of excellent visualization and precise dissection, blood loss can be as little as 1/10th that of traditional surgery.
5. Better oncology outcomes
   With the excellent visualization and precise dissection possible with robotic surgery, we are able to dissect lymph nodes out more thoroughly, with preservation of important nerves and blood vessels that are normally not well visualized with open surgery.
6. Better Cosmesis
   Instead of a large 12-14" vertical abdominal incision, patients only have a few small laparoscopic incisions.
7. Less wound infection and wound complications
   Many patients with cancer have other illnesses that predispose them to wound healing complications - such as diabetes, obesity, hypertension, peripheral vascular disease. Some reports note a wound infection/complication rate for these patients as high as 20% after traditional surgery. By eliminating the large open incision, most of these wound complications are avoided. Even if a wound infection develops, it is much easier to treat a small 1/2" infected wound, than a large 12" infected wound.
8. Better Visualization
   Traditional laparoscopy uses a small camera on the end of an instrument with the image projected onto a standard TV monitor. With this system, there is no depth perception. The daVinci system utilizes 2 cameras located side-by-side within a single instrument. Each image is then projected to a separate screen that is dedicated to either the right or left eye. What the physician sees is a true 3-D image with excellent depth perception. This allows safer, more precise tissue dissection. In addition, the image is magnified 10x before being projected, thus allowing the surgeon to see structures never before visualized adequately with open surgery.
9. Better precision
   While no surgeon likes to admit it, there is always a bit of tremor when operating with long open instruments. Try it yourself - see how much fine control you have using a 12" long instrument at the end of your fingers. Robotic surgery completely eliminates this. All tremor and extraneous movement is removed by the computer before being communicated to the instruments. In addition, scaling features are available allowing one to program the instrument to move only 1" for every 5" the surgeon moves the controls.

Procedures and Conditions Treatable with Robotic surgery

• Hysterectomy for Endometrial cancer and hyperplasia (pre-cancer) 
Cervical dysplasia and cancer
• Complex ovarian masses suspicious for cancer
• Severe endometriosis
• Vaginal vault suspension for pelvic floor prolapse
• Staging/lymphadenectomy for gynecologic malignancies

Learn More


For additional information on minimally invasive surgery with the da Vinci® Surgical System, visit www.davincisurgery.com.

While clinical studies support the effectiveness of the da Vinci® System when used in minimally 
invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may 
not be appropriate for every individual. Always ask your doctor about all treatment options, as 
well as their risks and benefits.

The robotic system is used to assist with a variety of complex, minimally-invasive laparoscopic operations for benign and malignant female pelvic conditions. This surgery is especially useful in the performance of hysterectomies, removal of fibroids while preserving the uterus and for the treatment of certain gynecological cancers.

Patients undergoing laproscopic procedures typically experience less pain, have fewer instances of infection and recover more quickly than those undergoing open surgery.