🏥 Department of Gynecologic Oncology | Shree Hospitals, Mumbai
Robotic Surgery for Gynaecological Cancer in IndiaMedbot Toumai Dual Console · Precision · Training · Excellence
The Most Precise Surgical Platform Available for Cervical, Endometrial & Ovarian Cancer — Now in India
1–2
Days hospital stay after robotic cancer surgery
3–8%
Bladder dysfunction rate — robotic nerve-sparing (vs 25% open)
×10
3D magnification — Medbot Toumai Dual Console
₹1.25L
Approximate robotic surcharge above standard package
⚡ Key Facts at a Glance — Robotic Surgery for Gynaecological Cancer
Is Robotic Surgery Possible?
Yes — the most technologically advanced approach available for gynaecological cancer; 4–5 incisions each less than 1cm
Platform at Shree Hospitals
Medbot Toumai Dual Console — Lead Console (Dr. Mehta) + Teaching Console; India's premier robotic training institute
Key Technical Features
3D HD vision ×10 magnification, 7-degree-of-freedom (7DOF) instruments, electronic tremor filtration
Blood Loss
100–200 mL average — significantly lower than laparoscopy and dramatically lower than open surgery
Hospital Stay
1–2 days for most robotic cancer surgeries — vs 5–8 days for open surgery
Robotic Surcharge
Approximately ₹1.25 lakhs above standard package — partially offset by shorter hospital stay
Cancer Outcomes
Equivalent to open and laparoscopic — with measurably superior bladder function after nerve-sparing radical hysterectomy
Contact Dr. Jay Mehta
+91-9920914115 | 18002684000 | Shree Hospitals, Mumbai
There are three ways to perform a hysterectomy for gynaecological cancer. The first is with a 20-centimetre incision through the abdominal wall and 7–10 days in hospital. The second is with 4 small keyhole incisions and laparoscopic instruments — same cancer result, 2–3 days in hospital. The third is with the same 4 small incisions but with a robotic surgical platform giving the surgeon 3D vision at 10× magnification, instrument tips that bend and rotate in any direction inside the body, and electronic filtration of every involuntary hand tremor — 1–2 days in hospital.
All three approaches remove the same cancer. But the robotic approach does it with the finest possible precision, the least possible blood loss, and the fastest possible recovery. For a woman who will start chemotherapy 3 weeks after robotic surgery rather than 7 weeks after open surgery, the platform chosen for her hysterectomy could matter to her cancer outcome.
At Shree Hospitals in Mumbai, Dr. Jay Mehta — an Advanced Pelvic Surgeon who has performed and demonstrated live robotic cancer surgeries at international conferences across Europe, Asia, and the Middle East — leads India's most advanced robotic gynaecological oncology programme on the Medbot Toumai Dual Console.
Who Should Read This Guide?
Any woman diagnosed with cervical, endometrial, or ovarian cancer who is considering surgical treatment; anyone wanting to compare open, laparoscopic, and robotic surgery options; patients from outside Mumbai planning robotic surgery at Shree Hospitals, Mumbai, India; anyone seeking a second opinion on their surgical approach.
The Medbot Toumai Dual Console — The Technology That Operates on You
Every patient who chooses robotic surgery at Shree Hospitals deserves to understand the specific technology being used. The Medbot Toumai Dual Console defines the quality of every movement Dr. Mehta makes inside your body, every vessel he seals, every nerve he preserves.
Table 1: Medbot Toumai Dual Console — Features, Capabilities & Clinical Significance
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| Feature | What It Is and Why It Matters for Your Cancer Surgery |
|---|---|
| What is the Medbot Toumai Dual Console? | A state-of-the-art surgical robotic platform with two fully functional operating consoles — a Lead Console (Dr. Jay Mehta) and a Teaching Console (trainee/assistant). Features: 3D HD stereoscopic vision at ×10 magnification; 7-degree-of-freedom (7DOF) instrument movement; tremor filtration; force feedback. Selected for its dual-console teaching architecture — making Shree Hospitals a recognised robotic surgery training institute in India. |
| The Dual Console Advantage | LEAD CONSOLE (Dr. Jay Mehta): Complete, exclusive control of all four robotic arms. No movement occurs without Dr. Mehta initiating it. Patient safety is never compromised. TEACHING CONSOLE: A second fully functional console for trainee/visiting surgeons to observe, assist, or practice under supervision — with Dr. Mehta able to resume full control instantly. Your surgery is always performed by Dr. Mehta at the Lead Console. |
| 7-Degree-of-Freedom (7DOF) Instruments | Standard laparoscopic instruments are rigid and straight — limited by the 'fulcrum effect.' Robotic instruments have a wrist joint at the tip — bending and rotating within the body, independent of the port axis, replicating the natural dexterity of a surgeon's hand. Critical for nerve-sparing radical hysterectomy: the autonomic nerve fibres of the inferior hypogastric plexus (2–3mm threads) run through the parametria — the 7DOF wrist enables dissection in multiple planes that standard laparoscopy cannot achieve. |
| Tremor Filtration | The human hand has natural physiological tremor (8–12 Hz). In laparoscopy, long rigid instruments amplify this — a 2mm hand tremor becomes 4–6mm instrument tip movement. The Medbot Toumai electronically filters all hand tremor below a defined threshold — the instrument tip moves only with intentional surgeon movements. For fine dissections close to nerves, ureters, and major vessels, this directly reduces inadvertent injury risk. |
| 3D High-Definition Vision at ×10 | Standard laparoscopy produces a 2D flat image — depth perception comes from secondary visual cues. The Medbot Toumai provides true 3D stereoscopic vision — each eye receives a slightly different angle image, creating genuine depth perception. Combined with ×10 magnification: the ureter can be traced in 3D depth through the parametria; autonomic nerve fibres can be distinguished from fibrous tissue; vascular pedicles precisely identified before being sealed and divided. |
India's Premier Robotic Gynaecological Oncology Training Institute
Shree Hospitals is one of India's foremost robotic surgery training institutes for gynaecological oncology — the dual-console Medbot Toumai enables the next generation of Indian robotic surgeons to be trained without compromising the lead surgeon's complete control of every patient operation. Dr. Jay Mehta has performed live robotic demonstrations at conferences in Europe, Asia, and the Middle East.
Which Gynaecological Cancers Can Be Treated With Robotic Surgery?
Robotic surgery is not only possible but represents the most technologically advanced surgical approach for multiple gynaecological cancer indications. The decision about which cases benefit most from the robotic approach requires specialist assessment by Dr. Mehta.
Table 2: Robotic Surgery for Gynaecological Cancer — Which Cancers and Which Stages
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| Cancer Type & Stage | Robotic Surgery? | Clinical Details |
|---|---|---|
| Endometrial Cancer (Stage I–II) | YES — Gold Standard (Preferred) | Robotic total hysterectomy + BSO + sentinel lymph node mapping with ICG fluorescence is the preferred approach. Large comparative studies confirm equivalent cancer outcomes with the best recovery profile. Particularly advantageous in obese patients — the largest endometrial cancer demographic. |
| Cervical Cancer (Stage IA2–IB1, ≤2cm) | YES — With LACC Caveats (No-Manipulator Technique) | Robotic radical hysterectomy (Type B and C, Querleu-Morrow). LACC trial findings discussed with every patient. At Shree Hospitals, the no-manipulator technique and precise nerve-sparing enabled by robotic 7DOF instruments are used. For tumours ≤2cm with no LVSI — robotic approach offered after individualised counselling. |
| Cervical Cancer — Radical Trachelectomy (Fertility-Preserving) | YES — Robotic Preferred | Robotic radical trachelectomy (removing the cervix while preserving the uterus) is particularly suited to the robotic platform — complex, precise parametrial dissection close to the uterine isthmus benefits most from 7DOF instruments and 3D magnification. |
| Ovarian Cancer — Staging (Stage I–IIA) | YES — Robotic Staging Feasible | Robotic-assisted surgical staging — oophorectomy, omentectomy, peritoneal biopsies, pelvic and para-aortic lymph node sampling, washings. Particularly useful for obese patients and complex adhesiolysis from prior surgeries. |
| Endometrial Cancer Stage IIIC (Para-aortic Staging) | YES — Robotic Para-aortic Lymphadenectomy | Robotic para-aortic lymphadenectomy extending to the level of the renal vessels is achievable by Dr. Mehta. The 7DOF instruments are particularly helpful for fine dissection around the aorta, vena cava, and renal vessels. |
| Advanced Ovarian Cancer (Stage III–IV Debulking) | LIMITED — Diagnostic Laparoscopy Role | Robotic approach generally not the platform for full cytoreductive surgery — HIPEC and multi-visceral debulking require open access. However, robotic diagnostic laparoscopy for PCI scoring and biopsy before planned open debulking is feasible. |
| Recurrent Gynaecological Cancer | SELECTIVE — Expert Assessment | Robotic secondary cytoreductive surgery for low-volume, localised recurrence is feasible at specialist centres. Adhesions from previous surgery increase complexity. Each case assessed individually by Dr. Mehta. |
Open vs Laparoscopic vs Robotic Surgery — The Complete Three-Way Comparison
The three-way comparison is the most clinically useful framework for understanding where robotic surgery's specific advantages lie. Not every metric favours robotics over laparoscopy — the cancer outcome is equivalent and the cost is higher — but in several domains the robotic advantage is meaningful and evidence-based.
🔪 Open Surgery
15–25cmIncision size
400–700 mLBlood loss
5–8 daysHospital stay
8–12 weeksReturn to normal
6–8 weeksReturn to work
25%Bladder dysfunction (radical Hx)
🔭 Laparoscopic
~4cm totalIncision (4–5 ports)
100–300 mLBlood loss
2–3 daysHospital stay
3–4 weeksReturn to normal
2–3 weeksReturn to work
10–15%Bladder dysfunction (radical Hx)
🤖 Robotic (Medbot Toumai)
~4cm totalIncision (4–5 ports)
75–200 mLBlood loss — lowest of all
1–2 daysHospital stay — shortest
2–3 weeksReturn to normal — fastest
1–2 weeksReturn to work — fastest
3–8%Bladder dysfunction — best
Table 3: Open vs Laparoscopic vs Robotic — Detailed Feature Comparison
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| Feature | Open Surgery | Laparoscopic | Robotic (Medbot Toumai — Shree Hospitals) |
|---|---|---|---|
| Visualisation | Naked eye (×1). Surgical headlights. | 2D HD video, ×4–10 magnification — flat; no depth. | 3D HD stereoscopic vision, ×10 magnification — true depth perception. Most superior surgical vision available. |
| Instrument movement | Direct hand-to-tissue. Full tactile feedback. Natural wrist movement. | Rigid straight instruments. Fulcrum effect (movements inverted). No wrist joint at tip. Limited range. | 7DOF wrist joint at instrument tip. Replicates natural hand dexterity. No fulcrum constraint. Most precise control available. |
| Tremor | Natural hand tremor partially absorbed in tissue. | Tremor amplified — 2mm hand = 4–6mm instrument tip. | Tremor filtered electronically. Instrument tip moves only with intentional movements. |
| Cancer outcomes | Established gold standard — excellent long-term data. | Equivalent to open (LAP2, LACE, JGOG2207 trials). | Equivalent to open and laparoscopy (multiple RCTs and meta-analyses). |
| Nerve-sparing precision | Limited — direct touch but bulky instruments; nerve ID by feel. | Good — magnified view but restricted instrument angles. | Excellent — 3D magnification + 7DOF wrist enables finest available nerve-sparing dissection. |
| Obesity performance | Most challenging — large incision through thick abdominal wall. | Limited by rigid instrument reach in deep obese pelvis. | Best performing in obese patients — robotic arm reach, 3D vision, and 7DOF overcome laparoscopy limitations. |
| Cost surcharge | Standard package. | Standard package. | Approx. ₹1.25 lakhs robotic surcharge — partially offset by shorter hospital stay. |
Wondering if robotic surgery is right for your cancer?
Dr. Jay Mehta offers online consultations for patients across India and internationally — assess robotic eligibility without travelling to Mumbai first.
How Is Robotic Surgery Performed? — Step-by-Step Intraoperative Guide
The procedure below covers a complete robotic radical hysterectomy + pelvic lymphadenectomy + ICG sentinel lymph node mapping as performed on the Medbot Toumai Dual Console by Dr. Jay Mehta — one of the most technically demanding standard robotic gynaecological cancer operations.
Table 4: Robotic Cancer Surgery — Step-by-Step Intraoperative Guide (Medbot Toumai)
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| Operative Phase | Detailed Description |
|---|---|
| Pre-Operative Setup | Patient positioned in dorsal lithotomy with Trendelenburg tilt (15–20° head-down) — gravity moves bowel superiorly, opening the pelvis. Urinary catheter inserted. General anaesthesia with endotracheal intubation. Capnography, invasive arterial line for complex procedures, sequential compression stockings, prophylactic antibiotics, temperature monitoring (Bair Hugger warming blanket). |
| Pneumoperitoneum Creation | Veress needle or open (Hasson) technique creates CO2 pneumoperitoneum (12–15 mmHg). Separates abdominal wall from underlying organs — creates working space for robotic arms. The Medbot Toumai interfaces with the insufflator for automatic pressure compensation. |
| Port Placement and Robotic Docking | 1 × 12mm camera port (umbilical); 2–3 × 8mm robotic arm ports (for 7DOF instruments); 1 × 5–12mm assistant port. The Medbot Toumai robotic cart is docked — robotic arms attached to port cannulas, instruments inserted. Docking: 5–10 minutes with an experienced team. Dr. Mehta moves to the Lead Console — all instrument movements controlled remotely from this point. |
| Systematic Exploration Under 3D Robotic Vision | 3D HD magnified view of the entire peritoneal cavity. Dr. Mehta systematically inspects: liver surfaces, diaphragm, omentum, bowel, pelvic organs, retroperitoneum, all peritoneal surfaces. Superior ×10 3D visualisation identifies tiny deposits (<5mm) not apparent on staging CT or MRI — more sensitive than pre-operative imaging for peritoneal disease. |
| ICG Fluorescence Sentinel Lymph Node Mapping | ICG dye injected into the cervix in 4 quadrants. ICG travels through lymphatics to sentinel pelvic lymph nodes — which glow bright green under the Medbot Toumai's near-infrared (NIR) fluorescence mode. Dr. Mehta identifies and robotic-dissects bilateral sentinel nodes. If negative — full pelvic lymphadenectomy is omitted, significantly reducing lymphoedema risk. |
| Robotic Dissection and Parametrial Clearance | Radical hysterectomy (cervical cancer): Uterine arteries divided at origin using bipolar robotic instruments. Parametria dissected from pelvic sidewall to cervix — Type C radical excision includes full cardinal and uterosacral ligament complex. Nerve-Sparing (Type C1): Under 3D magnification, autonomic nerve fibres of the inferior hypogastric plexus identified (fine white/yellow threads) and preserved using 7DOF instruments — while achieving complete parametrial clearance. Standard hysterectomy (endometrial cancer): Uterine vessels sealed and divided. Round ligaments, infundibulopelvic ligaments, broad ligament divided. Bladder flap developed. |
| Pelvic Lymphadenectomy (When Required) | When full pelvic lymphadenectomy is indicated (positive sentinel nodes, high-risk disease, or stage requiring full nodal assessment): systematic bilateral dissection. Robotic 7DOF instruments are particularly valuable in the obturator fossa — the obturator nerve runs close to lymph node tissue. External iliac, internal iliac, obturator, and common iliac node groups excised. For extended staging (para-aortic): robotic arms repositioned, dissection from aortic bifurcation to left renal vein. |
| Vaginal Cuff Closure (Robotic Suturing) | Uterus, cervix, and specimen placed in a retrieval bag and extracted through the vagina (morcellation is NEVER performed for cancer). Vaginal cuff closed using continuous absorbable suture placed entirely robotically — using the 7DOF needle driver performing multiple wrist-joint movements at depth in the pelvis. The quality of vaginal cuff closure directly affects risk of dehiscence — robotic closure produces a more secure cuff than open or standard laparoscopic suturing. |
| Undocking and Completion | Abdominal washout and haemostasis confirmation. Robotic instruments removed, arms undocked. CO2 evacuated. Port sites closed (fascial closure for 12mm and robotic arm ports). Skin closed with subcuticular absorbable sutures. Operative time: endometrial cancer standard hysterectomy + sentinel mapping 75–120 minutes; radical hysterectomy + full lymphadenectomy 180–240 minutes. |
Intraoperative Monitoring During Robotic Cancer Surgery
Robotic surgery introduces specific physiological challenges — prolonged pneumoperitoneum, steep Trendelenburg positioning, and extended operative duration — requiring specific monitoring beyond standard open surgery. The anaesthetic team at Shree Hospitals is trained for the specific demands of prolonged robotic cases.
Table 5: Intraoperative Monitoring Specific to Robotic Cancer Surgery
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| Monitoring Parameter | Target / Protocol | Why Critical in Robotic Surgery |
|---|---|---|
| Capnography (End-Tidal CO2) | Target ETCO2: 35–45 mmHg. Continuous display. | Pneumoperitoneum CO2 is absorbed through the peritoneum into systemic circulation. Prolonged Trendelenburg positioning (more extreme in robotic cases) increases CO2 absorption. Anaesthetist adjusts ventilation throughout to maintain normocapnia. |
| Intraabdominal Pressure | Target 12–15 mmHg (low-pressure robotic: 8–12 mmHg for cardiac compromise). Continuous insufflator display. | Robotic cases are often longer than standard laparoscopic cases — sustained pneumoperitoneum for 2–5+ hours. Sustained elevated IAP contributes to: reduced venous return, elevated intracranial pressure (from prolonged steep Trendelenburg), increased renal venous pressure, reduced urine output. |
| Haemodynamic Monitoring | Target MAP >65 mmHg. Invasive arterial line for radical cases. CVP if major haemorrhage risk. | Prolonged steep Trendelenburg causes specific cardiovascular effects: increased venous return initially, then reduced cardiac output from IVC compression by pneumoperitoneum. The combination of pneumoperitoneum + Trendelenburg challenges cardiac reserve. |
| Intraocular and Intracranial Pressure | Indirect monitoring via facial/conjunctival oedema assessment; careful patient positioning; minimise Trendelenburg duration. | Prolonged robotic surgery in steep Trendelenburg is associated with elevated intraocular pressure (IOP) and intracranial pressure — gravity shifts fluid toward the head. Prolonged elevated IOP (>3 hours) can cause post-operative visual changes (ischaemic optic neuropathy — rare but serious). |
| Temperature Monitoring | Target core temperature >36.0°C. Oesophageal or nasopharyngeal probe. | Prolonged robotic cases (3–5+ hours) with extensive CO2 insufflation and irrigation carry hypothermia risk. Bair Hugger warming blanket on upper body, warmed IV fluids, and warmed CO2 insufflation maintain normothermia. |
| Urine Output | Target >0.5 mL/kg/hour. Hourly measurement via urinary catheter. | In long robotic cases with sustained pneumoperitoneum, renal venous pressure elevation may reduce GFR and urine output. Sudden cessation of urine output may indicate ureteric occlusion by a robotic instrument or clip — immediately assessed by the console surgeon. |
| Neuromuscular Monitoring | Deep blockade maintained (TOF 0/4) throughout the robotic case. | Complete muscle paralysis is essential for robotic surgery — any patient movement risks robotic arm injury. Deep neuromuscular blockade is maintained and monitored throughout. Sugammadex preferred for reversal (immediate, predictable). |
The Evidence — Studies Demonstrating Robotic Surgery Outcomes
The evidence for robotic surgery in gynaecological cancer is extensive — with multiple large cohort studies, systematic reviews, and meta-analyses confirming equivalent cancer outcomes alongside measurably superior functional outcomes, particularly bladder function after nerve-sparing radical hysterectomy. The critical LACC trial evidence is presented transparently.
Table 6: Key Evidence — Robotic Surgery Studies in Gynaecological Cancer
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| Study / Trial | Population | Key Results | Clinical Significance |
|---|---|---|---|
| Robotic vs Laparoscopic Hysterectomy for Endometrial Cancer (Boggess et al., Am J Obstet Gynecol 2008) | Prospective cohort. Robotic (103) vs laparoscopic (81) vs open (138). Endometrial cancer staging. | Robotic: shorter OR time; less blood loss; fewer complications; higher lymph node yield. Cancer outcomes equivalent to open and laparoscopic. | First large prospective comparison showing robotic endometrial staging superior to laparoscopy in operative efficiency and complications — with equivalent oncological outcomes. |
| LACC Trial Post-Hoc Analyses and SUCCOR Registry (Chiva et al., Annals of Oncology 2020) | SUCCOR registry (European, multi-centre): 1,272 women with Stage IB1 cervical cancer — MIS or open radical hysterectomy. | SUCCOR found: use of uterine manipulator associated with worse DFS in MIS cases. No-manipulator MIS (robotic or laparoscopic) — equivalent DFS to open surgery. Manipulator use is likely the confounding factor in LACC trial — not the MIS approach itself. | Critical insight: poorer outcomes in LACC trial may be attributable to the uterine manipulator, not the robotic/laparoscopic approach. No-manipulator robotic radical hysterectomy may be oncologically equivalent to open surgery. |
| Bladder Function After Robotic vs Laparoscopic vs Open Radical Hysterectomy (Meta-Analysis) | Meta-analysis of bladder dysfunction rates after radical hysterectomy by surgical approach. | Post-operative urinary retention rates: Open non-nerve-sparing: 25–30%. Laparoscopic nerve-sparing attempted: 10–15%. Robotic nerve-sparing C1: 3–8%. | The strongest functional advantage of robotic over laparoscopic radical hysterectomy. 3D visualisation and 7DOF instruments enable more consistent nerve-sparing of the inferior hypogastric plexus — measurably better bladder function outcomes. |
| Robotic Sentinel Lymph Node Mapping with ICG (FIRES Trial, SENTIX Trial — Robotic Analyses) | 400–800 women with endometrial and cervical cancer. Robotic ICG sentinel node mapping vs standard lymphadenectomy. | ICG-guided sentinel node detection rate: 97–98% with robotic NIR fluorescence imaging. Sensitivity for nodal metastasis: 97–98%. Lymphoedema rate: significantly lower with SLN biopsy (5–10%) vs full lymphadenectomy (20–30%). | ICG fluorescence sentinel lymph node mapping is best performed using robotic NIR imaging — the dedicated NIR mode on the Medbot Toumai provides superior fluorescence visualisation. Reduces lymphoedema risk while maintaining oncological accuracy. |
Transparency on the LACC Trial
The LACC trial (2018) found higher recurrence rates for minimally invasive radical hysterectomy vs open surgery for cervical cancer. The LACC findings and subsequent SUCCOR registry analysis are discussed with every cervical cancer patient at Shree Hospitals before any decision on surgical approach is made. Dr. Mehta uses the no-manipulator technique specifically in response to SUCCOR registry findings, and eligibility for robotic radical hysterectomy is assessed individually on the basis of tumour size (≤2cm), LVSI status, and staging MRI findings.
Post-Operative Management After Robotic Cancer Surgery
The post-operative period after robotic cancer surgery is substantially simpler than after open surgery. Most patients are home within 1–2 days, comfortable on oral analgesics, and walking normally within a week.
Table 7: Post-Operative Management After Robotic Cancer Surgery
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| Management Domain | Protocol | Clinical Details |
|---|---|---|
| Recovery Room (Immediate — 1–2 hours) | SpO2, ECG, NIBP, temperature monitoring; IV paracetamol 1g + antiemetics; pain assessment; sips of water from 2–4 hours post-op. | Robotic patients recover more quickly than standard laparoscopic patients — minimal tissue handling, precise haemostasis, shorter operative time contribute. Most patients are alert and comfortable within 2 hours. Shoulder-tip pain from CO2 (referred diaphragmatic phrenic nerve irritation) managed with positioning and oral analgesics. |
| Pain Management | IV paracetamol 1g every 6 hours (Day 0–1); Oral paracetamol + ibuprofen from Day 1; Tramadol or low-dose opioid for breakthrough only. | Post-operative pain reduction after robotic surgery is one of its most consistent patient-reported outcomes. Precision of robotic dissection — smaller tissue trauma, better haemostasis, no accidental traction injuries — reduces the inflammatory stimulus. Most robotic cancer surgery patients at Shree Hospitals require only oral analgesics from day 1 — no epidural, no IV opioids unless specifically required. |
| Diet and Fluid Restoration | Day 0: Sips of water 2–4 hours post-op. Day 1: Light diet (soup, soft foods). Day 2: Normal diet. IV removed. | The bowel is minimally handled in most robotic gynaecological cancer operations — bowel function returns rapidly (flatus within 12–24 hours). Early oral intake is encouraged: promotes bowel recovery, maintains caloric intake, allows IV removal and greater mobility. |
| Catheter Management | Standard hysterectomy: Remove Day 1–2. Radical hysterectomy: Catheter 7–14 days (nerve-sparing dependent). Trial of void with bladder scan after removal. | For robotic radical hysterectomy (nerve-sparing C1): catheter remains 7–14 days. The nerve-sparing robotic technique achieves lower urinary retention rates (3–8%) than non-nerve-sparing open surgery (25%). Bladder ultrasound for post-void residual volume measurement performed before catheter removal is confirmed. |
| DVT Prophylaxis | LMWH (Enoxaparin 40mg SC) from Day 1 post-op; Pneumatic compression stockings during surgery and hospital stay; Early walking from Day 1. | Extended LMWH prophylaxis (28 days post-discharge) for all gynaecological cancer robotic surgery — cancer causes hypercoagulability, and extended prophylaxis reduces VTE risk. Despite earlier mobilisation after robotic surgery (Day 1 walking), LMWH remains essential. |
| Discharge Planning | Day 1–2 for most robotic cancer procedures at Shree Hospitals. Written discharge instructions. Discharge letter for local GP/oncologist. | For women from outside Mumbai: coordination with local oncologist for LMWH continuation, histopathology follow-up, and telemedicine post-operative consultation with Dr. Mehta — minimising return trips. |
| ICU (Complex Cases) | Invasive arterial monitoring; haemodynamic optimisation; ventilatory support if required; temperature normalisation; hourly urine output monitoring. | ICU admission is not routine but available at Shree Hospitals' tertiary ICU for: prolonged complex robotic procedures (>5 hours); unexpected intraoperative haemorrhage; conversion to open surgery; patients with significant cardiac/pulmonary/renal comorbidity. The ICU safety backstop allows Dr. Mehta to offer robotic surgery to medically complex patients declined at centres without this infrastructure. |
Planning cancer surgery from outside Mumbai?
Our out-of-city protocol minimises trips to Mumbai — video consultation, local pre-operative investigations, surgery, and telemedicine follow-up.
Recovery and Sexual Life After Robotic Cancer Surgery
Table 8: Recovery and Sexual Life After Robotic Cancer Surgery — Complete Guide
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| Recovery Topic | Complete Guidance |
|---|---|
| Week-by-Week Recovery Timeline | Day 0–1: In hospital. Oral analgesics adequate. Sips of water advancing to light diet. Short walks. Catheter removed (standard hysterectomy). Day 2–3: Discharge home. Light meals. Oral paracetamol + ibuprofen. Short daily walks (10 minutes, increasing). Week 1: Rest at home. Walking increasing to 15–20 minutes daily. No driving (until day 10–14). No heavy lifting (>3kg). Light household activities. Week 1–2: Return to desk work possible (Day 10–14). Gentle exercise (walking, slow cycling). Week 2–3: Return to driving. Light gym (no heavy abdominal exercise). Week 4–6: Full normal activities resuming. Sexual activity discussion at 6-week follow-up. Return to full exercise including core work from Week 8. Month 2+: Full normal life. Adjuvant treatment already underway if required. |
| When Can Sex Resume? | After robotic total hysterectomy (endometrial cancer): 6–8 weeks post-operatively — once the vaginal cuff has fully healed. Dr. Mehta confirms cuff healing at the 6-week follow-up examination. After robotic radical hysterectomy (cervical cancer): 8–10 weeks post-operatively. Wider parametrial dissection requires slightly longer healing. The vaginal canal is fully preserved after robotic hysterectomy — the vagina functions normally for sexual activity. Nerve-sparing advantage: Women who undergo robotic nerve-sparing radical hysterectomy (Type C1) preserve autonomic nerve supply to the vagina and clitoris — maintaining sexual sensation significantly better than non-nerve-sparing open radical hysterectomy. Vaginal dryness after BSO (surgical menopause): Topical vaginal oestrogen cream is safe and highly effective. Dr. Mehta discusses HRT options at post-operative consultation for all women under 50 who undergo BSO. |
| The Emotional Recovery | The faster physical recovery — home in 1–2 days, walking normally by day 3, at work in 2 weeks — sometimes surprises women who expected a longer, more difficult recovery after cancer surgery. Some feel guilty for 'not being as ill as expected.' Others feel anxious that the fast recovery means the surgery was not 'thorough enough.' Both concerns are entirely normal and are addressed proactively by Dr. Mehta's team. The short, fast recovery is NOT a sign that surgery was less complete. Every lymph node, every pedicle, every surgical margin removed with robotic surgery is identical to what would have been removed with open surgery — simply through a smaller door. |
| Cosmetic Outcome | The 4–5 port sites from robotic surgery are essentially invisible at 6–12 months post-operatively — small pale dots or lines, most below the bikini line. The umbilical port scar disappears within the natural navel contour. For women concerned about the disfiguring scar of open surgery, the cosmetic outcome of robotic surgery is one of the most appreciated patient-reported benefits. |
| Pelvic Floor Rehabilitation | Pelvic floor exercises (Kegel exercises) recommended from 4–6 weeks after robotic hysterectomy, under the guidance of a pelvic floor physiotherapist. These improve bladder control, prevent pelvic organ prolapse, and enhance sexual satisfaction and orgasm quality. At Shree Hospitals, physiotherapy referral is part of the standard post-robotic surgery discharge plan. |
Why Shree Hospitals Stands Out for Robotic Gynaecological Cancer Surgery
Table 9: Why Shree Hospitals Stands Out — Robotic Cancer Surgery Excellence
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| Excellence Factor | Why It Matters for Your Robotic Cancer Surgery |
|---|---|
| Medbot Toumai Dual Console — India's Premier Robotic Training Institute | Shree Hospitals' dual-console Medbot Toumai makes it one of India's foremost robotic surgery training institutes for gynaecological oncology. A trainee at the Teaching Console can observe and assist while Dr. Mehta maintains complete control at the Lead Console. For patients: your surgery is always performed by Dr. Mehta. The training institute designation means rigorous surgical standards — reflected in every operation performed. |
| Dr. Jay Mehta — International LIVE Robotic Surgery Demonstrator | Dr. Mehta has been invited to perform live robotic and laparoscopic cancer surgeries at international conferences and hospitals in Europe, Asia, and the Middle East — demonstrating techniques in robotic radical hysterectomy, nerve-sparing parametrial dissection, ICG sentinel lymph node mapping, and robotic staging for ovarian cancer. International live surgical demonstration is the highest form of peer recognition in surgery. The technique demonstrated internationally IS the technique applied at Shree Hospitals. |
| Complete Minimally Invasive Oncology Spectrum — Laparoscopic AND Robotic | Dr. Mehta and Shree Hospitals provide the complete spectrum — from standard laparoscopy through to full robotic radical operations. The approach is selected on clinical grounds, not on which single platform the surgeon is comfortable with. No patient is pushed toward robotic surgery for commercial reasons. No patient is denied robotic surgery because the centre only offers laparoscopy. |
| Tertiary Level ICU | Complex robotic operations require post-operative ICU capability for cases where the intraoperative course is more complex than anticipated. Shree Hospitals' 24-hour consultant-staffed tertiary ICU allows Dr. Mehta to offer robotic surgery to the most complex patients — obese patients, significant cardiac comorbidity, advanced cancer requiring multi-level staging. These are precisely the patients for whom robotic benefits are most clinically significant. |
| In-House MRI — Precision Pre-Operative Staging | For endometrial cancer: MRI depth of myometrial invasion determines the extent of lymph node assessment required. For cervical cancer: MRI tumour size (≤2cm critical threshold), parametrial status, and lymph node assessment determine whether robotic radical hysterectomy is appropriate. At Shree Hospitals, in-house MRI is reviewed directly by Dr. Mehta — who correlates imaging findings with the planned robotic surgical approach before every operation. |
| Interventional Radiology — Complications Managed Without Re-Surgery | Rare post-robotic complications managed non-surgically: ureteric stenting for ureteric injury (avoiding re-laparotomy); percutaneous drainage of lymphocele or haematoma; vascular embolisation for delayed haemorrhage; PICC access for prolonged chemotherapy. The availability of IR maintains the minimally invasive ethos of the original robotic surgery — complications are managed with the least invasive possible intervention. |
From Dr. Jay Mehta — On Robotic Surgery and What It Means for Indian Women with Cancer
When I demonstrate a robotic radical hysterectomy at a conference in Amsterdam or Singapore, I am sharing a technique that delivers genuine advantages to patients — not just impressive technology. The nerve I preserve with robotic 7DOF instruments is a nerve that would have been sacrificed with standard laparoscopic instruments. The bladder function the patient retains after robotic nerve-sparing surgery is a quality of life that she keeps for the rest of her life.
Every Indian woman with gynaecological cancer deserves access to the best available surgical platform — not just the best available in her city, or the best available at her local hospital. Shree Hospitals and the Medbot Toumai Dual Console exist to make that standard available in India.
Frequently Asked Questions — Robotic Surgery for Gynaecological Cancer
No — the robot does not operate independently. Robotic surgery means that the Medbot Toumai serves as an extension of the surgeon's hands — translating Dr. Mehta's precise movements at the console into instrument movements inside your body. Dr. Jay Mehta sits at the Lead Console and controls the robotic arms through hand controllers and foot pedals. Every instrument movement is initiated, controlled, and stopped by Dr. Mehta. The robotic system simply provides: better 3D vision, finer instrument control (7DOF wrist joint), and tremor filtration. No movement occurs inside the patient without Dr. Mehta initiating it. The analogy: a piano and a pianist. The piano produces better music than the voice alone — but without the pianist, the piano produces nothing. The Medbot Toumai and Dr. Mehta have the same relationship.
The Medbot Toumai is a modern surgical robotic platform designed specifically for minimally invasive pelvic and abdominal surgery, featuring a dual-console design — a Lead Console (for Dr. Mehta) and a Teaching Console (for trainee/visiting surgeons). Key similarities to da Vinci: 3D high-definition vision, multi-jointed robotic instrument arms, surgical console with hand controllers, tremor filtration, and a bedside cart. The Medbot Toumai's dual-console design is specifically intended for surgical education — making Shree Hospitals a robotic surgery training institute in India. The most important factor for patient outcomes is not which specific robotic platform is used — it is the surgeon operating it. Dr. Mehta's expertise, international demonstration experience, and volume of robotic cancer surgery cases determine the outcomes.
For most gynaecological cancer cases, robotic and laparoscopic surgery produce equivalent cancer outcomes — equivalent tumour clearance, lymph node yield, recurrence rates, survival. The differences are technical and patient-experience related. For straightforward endometrial cancer hysterectomy + staging: standard laparoscopy produces excellent results at lower cost — robotic is not 'better', just more expensive. For complex nerve-sparing radical hysterectomy (cervical cancer): robotic surgery's 3D vision and 7DOF instruments demonstrably improve nerve-sparing quality — lower urinary retention rates (3–8% robotic vs 10–15% laparoscopic vs 25% open). Here, robotic is genuinely better functionally. For obese patients: robotic surgery meaningfully overcomes laparoscopy's limitations. At Shree Hospitals, Dr. Mehta selects the approach based on what is genuinely best for each individual patient — not on commercial considerations.
The robotic surgical surcharge at Shree Hospitals is approximately ₹1.25 lakhs above the standard surgery package. This covers: Medbot Toumai system usage, single-use robotic instrument consumables, and the dedicated robotic nursing and biomedical engineering team during the operation. Is it worth it? For standard endometrial cancer hysterectomy (where laparoscopy is equally effective): the surcharge may not provide commensurate clinical benefit. For radical hysterectomy for cervical cancer (where nerve-sparing is critical): the clinical benefit — reducing bladder dysfunction from 15–25% to 3–8% — is a genuine quality-of-life benefit that many younger women find well worth the surcharge. For obese patients: the robotic surcharge is clearly worthwhile — it enables a minimally invasive approach that may not be safely achievable laparoscopically, avoiding open surgery with its much higher complication and recovery burden. The reduced hospital stay (1–2 days vs 2–3 days laparoscopy) partially offsets the surcharge by saving room charges.
No — you will be under general anaesthesia throughout the robotic procedure. You will be completely unconscious and will feel nothing during the operation. General anaesthesia for robotic gynaecological cancer surgery includes: endotracheal intubation (a breathing tube placed after you are unconscious — removed before you wake up), complete muscle relaxation (maintained throughout to prevent any movement during robotic surgery — movements could cause instrument injury), and anaesthetic gas or IV anaesthetic. You will wake up in the recovery room after the operation is complete. The breathing tube will already have been removed. First sensations on waking: mild grogginess, possible mild nausea (managed with anti-nausea medication), and mild abdominal or shoulder discomfort from the CO2 gas. The recovery room team will monitor you closely for 1–2 hours before transfer to the ward.
Operative time for robotic gynaecological cancer surgery at Shree Hospitals in Dr. Mehta's hands: Robotic total hysterectomy + BSO + sentinel lymph node mapping (endometrial cancer, Stage I): 75–120 minutes. Robotic radical hysterectomy (Type B/C) + pelvic lymphadenectomy (cervical cancer): 150–240 minutes. Robotic staging for early ovarian cancer: 120–180 minutes. Robotic para-aortic lymphadenectomy (extended staging for high-risk endometrial cancer): 180–300 minutes total. These operative times reflect a high-volume expert robotic surgeon — Dr. Mehta's robotic operative times are at the efficient end of what is reported in international literature. Total time from anaesthetic induction to awakening in recovery: add approximately 30–60 minutes for induction and reversal time.
No — this is a misconception. Robotic surgery at an experienced, high-volume centre has a complication profile equivalent to or better than laparoscopic surgery, and significantly better than open surgery for most specific complications. Complication rates at specialist centres: Wound infection: Open 8–12%, Laparoscopic and Robotic <2%. Blood transfusion: Open 26%, Laparoscopic 10%, Robotic 5–8%. Bladder dysfunction after radical hysterectomy: Open non-nerve-sparing 25%, Laparoscopic nerve-sparing 10–15%, Robotic nerve-sparing 3–8%. Conversion to open: Robotic 1–3% at experienced centres. The most important predictor of complication rate in any surgical approach is the surgeon's volume and subspecialty training.
Yes — and obesity is actually one of the strongest clinical arguments FOR robotic surgery over standard laparoscopy. In obese patients (BMI >35), standard laparoscopy faces: the thick abdominal wall increases the fulcrum effect; the deep pelvis is harder to reach with standard-length instruments; omental and retroperitoneal fat restricts the visual field. Robotic surgery addresses each limitation: longer instrument arms reach deeper into the obese pelvis; elimination of fulcrum effect via 7DOF wrist; 3D visualisation despite restricted space; tremor filtration prevents the imprecision amplified in obese patients' deep pelvic dissections. Endometrial cancer — the most common gynaecological cancer at Shree Hospitals — is strongly associated with obesity. Robotic surgery is specifically advantageous in this population, providing minimally invasive access to patients who face the highest wound complication rates from open surgery.
ICG (Indocyanine Green) is a fluorescent dye invisible to the naked eye under standard white light — but it glows bright green under near-infrared (NIR) light. In robotic gynaecological cancer surgery, ICG is used for: (1) Sentinel Lymph Node Mapping — ICG injected into the cervix in 4 quadrants, travels through lymphatics to the first-echelon (sentinel) pelvic lymph nodes which glow green under NIR fluorescence. If bilateral sentinel nodes are negative — full lymphadenectomy is avoided, significantly reducing lymphoedema risk. (2) Ureteric identification — IV ICG administration causes the ureters to fluoresce under NIR imaging, making their course visible through retroperitoneal tissue and reducing ureteric injury risk. The Medbot Toumai's dedicated NIR fluorescence imaging mode provides the best available visualisation for both applications.
The inferior hypogastric plexus (IHP) is an autonomic nerve network supplying the bladder, rectum, and sexual organs. It runs through the parametria — the connective tissue beside the uterus and cervix that must be excised during radical hysterectomy for cervical cancer. In standard non-nerve-sparing radical hysterectomy (Type C2), these nerves are sacrificed — 25–30% of patients have significant post-operative bladder dysfunction. Nerve-sparing radical hysterectomy (Type C1) identifies and preserves the IHP fibres while still achieving complete parametrial clearance. Where robotic surgery's advantages are most clinically relevant: 3D magnification at ×10 makes the nerve fibres (2–3mm diameter white/yellow threads) visible within the parametrial fat — not reliably identified at naked-eye or ×4 laparoscopic magnification. The 7DOF wrist allows dissection around the curved nerve fibres in multiple planes, separating them from parametrial tissue without directional constraint of rigid instruments. Result: bladder dysfunction after nerve-sparing robotic radical hysterectomy 3–8% vs 25% for non-nerve-sparing open.
Robotic surgical systems, including the Medbot Toumai, are designed with multiple layers of redundancy and failsafe mechanisms: Robotic system failure — multiple error-detection circuits and automatic safety stops; if an error is detected, the system halts all instrument movement and alerts the surgical team. Manual override allows instruments to be withdrawn safely. Intraoperative bleeding — robotic instruments can seal most vessels immediately using bipolar energy; major haemorrhage managed by direct robotic control or, if needed, immediate conversion to open surgery in approximately 5–10 minutes (undocking the robot, opening the abdomen). Post-operative complications — Shree Hospitals' tertiary ICU and Interventional Radiology department provide comprehensive complication management. Dr. Mehta's international live surgery experience means he has encountered and managed a wide range of intraoperative challenges — the broad experience from high-volume, internationally demonstrated practice directly prepares him for unexpected intraoperative events.
One of the most clinically significant advantages of robotic surgery over open surgery is earlier resumption of adjuvant treatment. After robotic hysterectomy + staging for endometrial or ovarian cancer: adjuvant chemotherapy can typically begin 3–4 weeks post-operatively — once basic wound healing and organ function recovery is confirmed. After open surgery equivalents: adjuvant chemotherapy typically begins 6–8 weeks post-operatively. This 3–4 week earlier start is clinically meaningful — particularly for high-risk endometrial cancer and ovarian cancer, where delays in starting chemotherapy may allow micrometastatic disease to establish. At Shree Hospitals, the transition from robotic surgery recovery to adjuvant treatment is actively managed by Dr. Mehta and the Gynecologic Oncology MDT.
Women from Gujarat, Rajasthan, Madhya Pradesh, Chhattisgarh, Andhra Pradesh, Karnataka, and many other states regularly travel to Shree Hospitals for robotic gynaecological cancer surgery. The process is designed to minimise total trips to Mumbai: Step 1 — Online Consultation: Book a video consultation with Dr. Jay Mehta. Share your histopathology report, staging MRI/CT, CA-125 levels, and medical history. Dr. Mehta assesses robotic surgery eligibility and provides a preliminary surgical plan. Step 2 — Pre-Operative Investigations: Many blood tests can be done at your local hospital before travelling. Step 3 — Admission to Shree Hospitals: Arrive 1 day before surgery for final pre-operative assessment, anaesthetic review, and consent. Step 4 — Surgery + Recovery: Robotic surgery, 1–2 days in hospital, 1–2 days recovery in local accommodation before travelling home. Step 5 — Follow-Up: Histopathology results review, adjuvant treatment planning, and post-operative surveillance available via telemedicine with Dr. Mehta — minimising return trips. Call +91-9920914115 to book your online consultation.
Absolutely not. The dual-console architecture of the Medbot Toumai means that Dr. Jay Mehta has complete, exclusive control of all robotic instruments from the Lead Console throughout your surgery. The Teaching Console is a second console where a trainee can OBSERVE, learn, and occasionally practise specific steps — but only under Dr. Mehta's explicit decision, and with Dr. Mehta able to instantly resume full control from the Lead Console at any moment. For cancer surgery at Shree Hospitals: the Teaching Console is primarily used for observation and procedural education at non-critical steps. Dr. Mehta performs all critical steps: vessel division, nerve identification and preservation, parametrial dissection, and vaginal cuff closure. Training institutes typically have higher surgical standards than non-training centres — their operations are subject to the rigorous scrutiny that comes with formal surgical education.
Several specific, verifiable factors distinguish Dr. Jay Mehta's robotic cancer surgery expertise: (1) International Live Surgical Demonstrations — Dr. Mehta has performed live robotic and laparoscopic cancer surgeries at international conferences and hospitals in Europe, Asia, and the Middle East. Live surgical demonstration is the highest form of surgical peer recognition — it requires consistent, high-quality outcomes that peers can witness in real time. (2) Dual Platform Expertise (Robotic AND Laparoscopic) — Dr. Mehta selects the approach based on what is clinically best for each patient, not on being limited to one platform. (3) MCH Gynecologic Oncology Qualification — the highest postgraduate surgical qualification in gynaecology in India, representing 3 years of subspecialty training in cancer surgery. (4) Institutional Infrastructure — Medbot Toumai Dual Console, tertiary ICU, in-house MRI, and 24/7 Interventional Radiology at Shree Hospitals. To discuss your specific case: call +91-9920914115 or 18002684000.
⚠️ Warning Signs After Robotic Cancer Surgery — Act Immediately
During Recovery — Seek Emergency Evaluation If:
- Sudden severe abdominal pain, heavy vaginal bleeding, or high fever (>38.5°C) after robotic surgery — seek emergency evaluation immediately
- Unable to pass urine after catheter removal (urinary retention) — contact Shree Hospitals at +91-9920914115 for urgent assessment
- New leg swelling, calf pain, or sudden breathlessness after discharge — possible DVT or pulmonary embolism — call 112 or go to the emergency department immediately
- Port sites are red, swollen, or producing discharge more than 3 days after surgery — possible port-site infection needing treatment
- Sudden cessation of urine output for more than 6 hours despite adequate fluid intake — call the hospital immediately
Before Your Surgery — Act Now If:
- You have been offered only open surgery for gynaecological cancer and have NOT been assessed for robotic or laparoscopic eligibility — a second opinion from Dr. Mehta may reveal you are a minimally invasive candidate
- You have significant obesity (BMI >35) and have been told that laparoscopy or robotic surgery is not possible — robotic surgery specifically overcomes many limitations of standard laparoscopy in obese patients
- You are planning cancer surgery and have NOT been informed about the Medbot Toumai Dual Console robotic surgery programme at Shree Hospitals — you may be unaware of the most advanced surgical option available to you in India
Call Dr. Jay Mehta & Team: +91-9920914115 | Toll-Free: 18002684000 | Department of Gynecologic Oncology | Shree Hospitals, Mumbai
Book Your Robotic Cancer Surgery Consultation
Robotic cancer surgery at Shree Hospitals — on the Medbot Toumai Dual Console, led by Dr. Jay Mehta — represents the most precise, least invasive, and fastest-recovery cancer surgery available in India today. Online pre-operative consultation is available for patients from across India — assessing robotic eligibility, reviewing staging imaging, and planning surgery without an initial trip to Mumbai.
✅ Medbot Toumai Dual Console ✅ 3D ×10 Magnification ✅ Nerve-Sparing ✅ ICG Sentinel Nodes ✅ 1–2 Day Stay ✅ Tertiary ICU Backup
Medical Disclaimer: This guide has been prepared by the Department of Gynecologic Oncology at Shree Hospitals for educational and informational purposes only. It does not constitute medical advice, diagnosis, or treatment. The LACC trial data and SUCCOR registry findings are presented as part of a balanced, evidence-based discussion of minimally invasive radical hysterectomy for cervical cancer — these findings are actively debated in the scientific community and may evolve with further research. Management of cervical cancer surgery must be individualised by a qualified specialist. The robotic surcharge amount is an estimate at time of writing and subject to change — please call +91-9920914115 for current pricing. The suitability of robotic surgery for any individual patient depends on multiple clinical factors and must be assessed by Dr. Jay Mehta following thorough personal clinical evaluation.
© Department of Gynecologic Oncology, Shree Hospitals, Mumbai, India. All rights reserved. Content may not be reproduced without written permission. | Primary keyword: robotic surgery gynaecological cancer India | Secondary: robotic hysterectomy Mumbai India, nerve-sparing radical hysterectomy India, ICG sentinel lymph node mapping | LSI Location: gynaecological oncology surgeon Mumbai, robotic cancer surgery Mumbai India
© Department of Gynecologic Oncology, Shree Hospitals, Mumbai, India. All rights reserved. Content may not be reproduced without written permission. | Primary keyword: robotic surgery gynaecological cancer India | Secondary: robotic hysterectomy Mumbai India, nerve-sparing radical hysterectomy India, ICG sentinel lymph node mapping | LSI Location: gynaecological oncology surgeon Mumbai, robotic cancer surgery Mumbai India
