The short answer: For most early cervical cancers (bachedani ke muh ka cancer, बच्चेदानी के मुँह का कैंसर), open radical hysterectomy (through a cut in the tummy) is the standard, because it has the best proven results. Laparoscopic and robotic (keyhole) radical hysterectomy use small cuts and usually mean a shorter hospital stay and a quicker recovery, but a large 2018 study (the LACC trial) found that the cancer came back more often, and survival was lower, after keyhole or robotic surgery than after open surgery. Keyhole or robotic surgery is therefore considered only for selected women with a small tumour (usually under 2 cm), after this evidence has been discussed. This is different from womb (endometrial) cancer, where keyhole and robotic surgery suit most early cases.
Below, each approach is compared in plain terms, followed by what the LACC trial found and how the choice is made for you.
On this page
- Open radical hysterectomy
- Laparoscopic radical hysterectomy
- Robotic radical hysterectomy
- The LACC trial and what it changed
- How the right approach is chosen
Open radical hysterectomy
- The standard approach for most early cervical cancers, with the best proven cancer results
- Done through one cut in the tummy, either up-and-down (midline) or across the bikini line (transverse)
- Good access when the anatomy is difficult, for example after previous surgery
- Longer hospital stay (often about 6–8 days)
- Longer recovery at home (about 6–8 weeks)
- More pain in the first days after surgery, managed with medicines
- A larger visible scar
Laparoscopic radical hysterectomy
- 4–5 small cuts; the surgeon holds the instruments directly and watches a screen
- Shorter hospital stay (often about 3–4 days)
- Quicker recovery and less pain in the first days
- For cervical cancer: the LACC trial found the cancer came back more often and survival was lower than after open surgery
- For cervical cancer it is now considered only for selected small tumours (usually under 2 cm), after discussing this evidence; it is still widely used for non-cancer conditions and for most early womb cancers
Robotic radical hysterectomy
- A form of keyhole surgery with similar small cuts; the surgeon controls the instruments from a console
- Magnified 3D view and instruments that bend like a wrist, which help the surgeon work in a small space; this has not been shown to make radical hysterectomy safer for cervical cancer
- Shorter hospital stay (often about 3–4 days)
- Quicker recovery and less pain in the first days
- Higher cost, because of the equipment
- For cervical cancer: robotic operations were included in the LACC trial and the same concern applies. Robotic surgery is not the better or safer choice for most women; it is considered only for selected small tumours (usually under 2 cm), after discussing this evidence
Robotic surgery is a good option for other conditions, such as most early womb cancers. Read more about when robotic surgery is appropriate.
The LACC trial and what it changed
The LACC trial (2018) was a large international study in which women with early cervical cancer were randomly assigned to open surgery or to keyhole (laparoscopic or robotic) radical hysterectomy. Women who had keyhole or robotic surgery had their cancer come back more often and had lower overall survival. This finding changed practice worldwide. Later research has looked at why, for example:
- Whether results differ with tumour size; some studies suggest the difference may be smaller for tumours under 2 cm, which is why keyhole surgery is still discussed for selected small tumours
- Whether surgical technique matters, such as avoiding a device placed inside the womb to move it during surgery (a uterine manipulator) and closing the vagina around the tumour before it is removed
This research has not overturned the LACC result. Current practice: open radical hysterectomy is the standard for most early cervical cancers (usually stage IA2 to IB2). Laparoscopic or robotic surgery is considered only for selected small tumours (usually under 2 cm), after the surgeon has explained this evidence to you. Larger or more advanced cervical cancers are usually treated with chemoradiation (radiotherapy, or sikai, given with chemotherapy) instead of surgery. Our guide to cervical cancer diagnosis and care explains the other treatment options.
How the right approach is chosen
Factors considered:
- Tumour size and stage
- Disease characteristics on MRI
- Patient anatomy (BMI, prior abdominal surgery)
- Surgeon experience with each approach
- Centre infrastructure
- Your own preference, once the options and the LACC evidence have been explained
For cervical cancer, the starting point for most women is open surgery; a smaller-cut approach is discussed only if your tumour is small and the other factors allow it. It may help to go through these questions to ask before robotic hysterectomy before your appointment.
See radical hysterectomy, Sterling robotic page, cost comparison.
FAQs
Is robotic surgery better or safer than open surgery for cervical cancer?
Not for most women. The 2018 LACC trial found that women with early cervical cancer who had keyhole or robotic radical hysterectomy had their cancer return more often, and lower survival, than women who had open surgery. Robotic surgery does mean smaller cuts and a quicker recovery, and it remains a good option for many other gynaecological cancers, such as most early womb cancers. For cervical cancer, open surgery is the standard; robotic surgery is considered only for selected small tumours (usually under 2 cm) after this evidence has been discussed with you.
Will my cancer come back faster after robotic vs open?
For cervical cancer, the LACC trial found that the cancer came back more often after keyhole or robotic radical hysterectomy than after open surgery. That is why open surgery is the standard for most women, and robotic surgery is considered only for selected small tumours (usually under 2 cm) after this has been discussed with you. Your own risk also depends on the stage, the final report on the removed tissue and any treatment after surgery, so ask your surgeon what applies to you.
Is robotic available in Ahmedabad?
Yes, robotic surgery is available in Ahmedabad. For cervical cancer it is considered only for selected small tumours (usually under 2 cm); for most women open surgery is recommended. Dr. Nishtha Tripathi Patel will explain which approach suits your stage. See our page on radical hysterectomy at Sterling Hospitals.
Can I choose the approach?
Yes — within clinical appropriateness. The surgeon discusses options and recommends what is right for your specific cancer. Final decision is shared.
What about endometrial cancer?
Womb (endometrial) cancer behaves differently. For most early womb cancers, keyhole or robotic surgery gives cancer results similar to open surgery, with a quicker recovery, so it is often preferred. Whether it suits you still depends on your scans, your health and the type of cancer.
Reviewed by Dr. Nishtha Tripathi Patel, MBBS, DGO, DNB, Fellowship Gynaecological Oncology, ESGO-certified. To book: WhatsApp +91 76988 00333.