Director, Surgical Oncology, Fortis Escorts, Okhla, New Delhi
Part 3 of 11 in Advanced Treatments in Gynaec Oncology
From Open Surgery to Robotics: The Shift in Gynaecologic Cancer Surgery
Gynaecologic cancer surgery has passed through three distinct phases: open surgery, laparoscopic surgery, and now robotic surgery. Each shift changed not just how the operation is performed but how quickly a patient recovers and returns to normal life.
Why robotic surgery outperforms open surgery
The advantages are consistent across case types: less morbidity, less post-operative pain, both acute and chronic, shorter hospital stays, less time in intensive care, and a faster return to normal life and work. Surgeons operate seated at a console rather than standing over an open incision, which changes the physical demands of a long operation as much as it changes the patient's experience of one.
Two decades of laparoscopy, four years of robotics
Laparoscopic cancer surgery has been standard practice in India for roughly two decades, long enough that Dr. Pandit's team has built what he describes as the largest private-sector series of endometrial cancer surgeries done laparoscopically in India. Robotic surgery is newer, in use in his practice since 2021, a four-year period across which the team has completed 100 to 200 robotic gynaecologic cancer cases, with outcomes he describes as equal in oncological clearance to open surgery, alongside lower morbidity and mortality.
Preserving fertility and sparing lymph nodes
Two techniques stand out for how they change a patient's actual experience of treatment rather than just the surgeon's. Fertility-sparing surgery, used for early-stage cancers, avoids removing the uterus or ovaries where the cancer's stage allows it. Sentinel lymph node dissection, guided by ICG dye, identifies the specific lymph node a tumour actually drains to and removes only that one, instead of clearing the entire pelvic lymph node chain and the lasting side effects that come with it.
Teaching the technique, not just performing it
Dr. Pandit's own recorded demonstration of a safe dissection technique for radical hysterectomy in endometrial and early cervical and ovarian cancer has been viewed more than 100,000 times on his YouTube channel and is used for teaching in multiple medical colleges. His hospital also runs fellowship and observership programmes for gynaecologists and surgeons who want hands-on training in laparoscopic and robotic radical hysterectomy.
This guide is based on a live Jivo Masterclass — Dr. Archit Pandit taught doctors across Africa on June 22, 2025.
FROM THE LIVE Q&A
Dr. William Gadaga (Zimbabwe)
What is the utility of high-intensity focused ultrasound (HIFU) therapy for gynaecologic malignancies, is it available at your institution, and what does it cost?
Dr. Archit Pandit
Dr. Pandit said focused high-frequency ultrasound therapy is generally used for small fibroids rather than malignancy, which is his own area of focus, but confirmed Fortis does perform it, at a cost of $4,500 to $6,500.
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Frequently Asked Questions
What advancements has Fortis made for African patients with gynaecologic malignancies, and what are the most recent and frequent surgical treatments and their estimated costs?▼
Dr. Pandit said no treatment is specific to African patients as such, but pointed to cancer vaccination, for cervical, genital, vaginal and vulval cancers, as an area worth spreading in Africa. On surgery, he named HIPEC as the most significant advancement, now used for ovarian cancer along with peritoneal, appendiceal, colon, rectal and some stomach cancers, transforming outcomes over the last 10 to 15 years for patients previously diagnosed too late for treatment. He also pointed to robotic and laparoscopic surgery for retroperitoneal lymph node dissection, endometriosis and radical hysterectomy, and to sentinel lymph node dissection, which avoids removing the full set of pelvic lymph nodes. Surgical costs range from $5,000 to $7,000, and HIPEC surgery costs $11,000 to $12,000.
Since HIPEC is used from stage three onward, is it possible to use HIPEC or another technology to operate on a stage two cervical cancer patient?▼
Dr. Pandit said no, HIPEC is not used for cervical cancer at all. It is limited to six cancers: peritoneal, appendiceal, ovarian, colon, rectal and some stomach cancers, and of the gynaecologic cancers, only ovarian and endometrial cancer qualify. Cervical cancer is treated with surgery in its early stages, and with chemotherapy, radiation and sometimes immunotherapy from stage 2B onward.
How can general practitioners from Africa access surgical training courses at Fortis?▼
After clarifying the question was about medicine-side doctors rather than surgeons, Dr. Pandit said they can join as observers, since hands-on training in India is reserved for foreign doctors who are themselves surgeons or gynaecologists. Observers get an overview of cancer care spanning preventive health checkups, medical oncology and surgical oncology, and can join the hospital's tumour board, the round-table meeting where the full team reviews each case against the current world literature.
What can be done to improve overall healthcare delivery to doctors and patients across Africa?▼
Varun, the session host, said this reflects the underlying model of the collaboration: connecting Indian specialists using current-day technology and treatment processes with doctors across Africa to help achieve better medical outcomes, and offered to continue the conversation with Dr. Sunday directly after the session.
What is the cost range for laparoscopic surgeries for gynaecologic oncology cases, and does the hospital offer chemoradiotherapy, IMRT and VMAT?▼
Dr. Pandit said laparoscopic cancer surgery, including radical hysterectomy and hysterectomy, typically costs between $5,000 and $5,500, while procedures for endometriosis such as myomectomy range from $5,000 to $6,500. Fortis offers the full range of radiation oncology, including 3D-CRT, IMRT, IGRT, 3D-ARC, CyberKnife and tomotherapy, as well as brachytherapy, and has access to targeted therapy, immunotherapy and, at one centre in India, CAR-T cell therapy.
In This Series: Advanced Treatments in Gynaec Oncology
- 1.Advanced Treatments in Gynaecologic Oncology
- 2.HIPEC: How Heated Chemotherapy Is Changing Outcomes in Advanced Ovarian Cancer
- 3.From Open Surgery to Robotics: The Shift in Gynaecologic Cancer Surgery
- 4.The Four Gynaecologic Cancers Every General Practitioner Should Know
- 5.HPV Vaccination and the Prevention of Cervical Cancer
- 6.Four Red Flags That Should Prompt a Gynaecologic Oncology Referral
- 7.Diagnostic Advances in Gynaecologic Oncology: Genetic Testing, PET-CT and AI
- 8.Targeted Therapy and Immunotherapy in Gynaecologic Cancers
- 9.Cost of Gynaecologic Cancer Surgery and Treatment in India
- 10.Complex International Cases in Gynaecologic and Surgical Oncology
- 11.Cross-Border Referral: How African Doctors Can Collaborate with Indian Gynaecologic Oncology Centres