CompletedInterventional

MIRRORS study – robotic surgery for advanced ovarian cancer

Treatment for advanced ovarian cancer usually involves chemotherapy followed by an operation to remove as much cancer as possible. Traditionally, this requires open surgery with a large cut down the tummy, which can involve a long, painful recovery and keep women in hospital for several days. The MIRRORS study is looking at whether robotic keyhole surgery is a safe and effective alternative. During robotic surgery, a specialist surgeon sits at a 3D computer console to guide miniature surgical tools through small cuts. Researchers hope this technique can remove just as much cancer as open surgery while causing less bleeding, lowering infection risks, and helping women get back on their feet sooner. A quicker recovery may also help patients restart chemotherapy without delay. Participants will be monitored during surgery and asked to fill in questionnaires about their recovery and wellbeing for three months.

At a glance

Status

Completed

Sponsor

Royal Surrey County Hospital NHS Foundation Trust

Enrolment target

Start

26 Jun 2020

Estimated completion

25 Jun 2021

Ovarian cancer

What is this study about?

Advanced ovarian cancer is often treated with a combination of chemotherapy and surgery. The main aim of the surgery is to clear away as much visible tumour as possible, because removing the cancer thoroughly helps patients live longer. Traditionally, surgeons must make a long, vertical cut down the tummy to view and reach all the tumour deposits. While this open surgery is standard practice, healing from a large wound can be difficult, painful, and carry a risk of complications like wound infections or blood clots.

Robotic surgery offers a different approach. It is an advanced type of keyhole surgery where the surgeon makes a few small cuts instead of one large one. Sitting at a special console in the operating theatre, the surgeon controls robotic arms with wristed instruments that move with great precision. It is important to understand that the robot does not perform the operation on its own—the surgeon controls every move. Because the cuts are much smaller, patients usually experience less pain, lose less blood, and spend fewer days in hospital.

The surgical team at the Royal Surrey NHS Foundation Trust has extensive experience with robotic surgery for women's cancers. Through the MIRRORS study, they want to find out whether robotic surgery can safely remove all visible cancer in women who have already received chemotherapy before surgery. They also want to understand if it improves recovery and quality of life compared with open surgery, making it easier for women to continue their cancer journey.

Key takeaways

Tests whether robotic keyhole surgery works as well as open surgery for advanced ovarian cancer.
Aims to reduce pain, shorten hospital stays, and speed up overall recovery after chemotherapy.
Surgeons will switch to open surgery straight away if needed to clear the cancer safely.
Includes an optional test using a special glowing dye to examine tumour blood vessels.
Taking part is voluntary and does not change your right to standard NHS cancer care.

Who may be eligible?

This trial is for adult women aged 18 and over who have been diagnosed with advanced ovarian cancer (stage 3c to stage 4b). To take part, you must have already had chemotherapy before surgery to help shrink the tumours, and your medical team must feel you are ready for an operation to remove the remaining cancer. The main tumour in your pelvis must also be 8 centimetres or smaller.

Your surgical team will review your scans in detail. If the cancer has spread in a way that requires specialist open surgery on other organs—such as your liver or upper stomach—you will not be able to join the study, as an open operation would be necessary for your safety.

There is also an optional sub-study using a fluorescent medical dye. If you wish to join that part, your kidneys must be working well, and you must not have an allergy to iodine or medical dyes, or an overactive thyroid gland.

Could this study suit you?

Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.

I am a woman aged 18 or older.
I have been diagnosed with advanced ovarian cancer (stage 3c to 4b).
I have already received chemotherapy before my planned surgery.
The main tumour in my pelvis is 8 cm or smaller.
I do not need open surgery from other surgical teams (such as liver specialists).
I am being treated at or can be referred to the Royal Surrey NHS Foundation Trust.

Answer every question to see your result.

What does participation involve?

If you take part, your surgery will start with a keyhole camera check (laparoscopy) to look inside your tummy. If the surgeon sees that it is safe to remove all the cancer using the robot, they will proceed with robotic surgery. If the cancer cannot be completely or safely removed with keyhole tools, the surgeon will switch to a standard open cut.

You can also choose to join an optional part of the study using a special glowing dye called indocyanine green (ICG). This dye is given through a drip to help doctors study the blood vessels around tumours under near-infrared light. Regardless of whether you have the dye, any abnormal tissue found will be removed as part of your standard cancer care.

Taking part also involves sharing your experiences. You will complete questionnaires before your operation, during your recovery, and at your routine three-month clinic visit. You will also be invited to take part in an audio-recorded interview about how you felt during recovery. After three months, the questionnaires stop, and your doctors will continue to check on your health through your regular NHS follow-up visits.

Potential risks and benefits

Potential benefits include having keyhole surgery rather than a large cut, which may result in less pain, fewer wound infections, smaller scars, and a faster return home. A quicker recovery may also help you restart chemotherapy on time. However, these benefits cannot be guaranteed. Like all major operations, risks include bleeding, wound or chest infections, blood clots, reactions to the anaesthetic, or accidental injury to nearby organs like the bowel or bladder. Rarely, bowel complications might require a stoma bag. If you join the optional dye study, there is a very small risk of an allergic reaction (less than 1 in 10,000). Joining the trial is entirely voluntary, and choosing not to take part or withdrawing at any point will not affect the standard of NHS care you receive.

Locations (1)

Some site locations are approximate. We're improving this — please verify with the trial team before travelling.

Royal Surrey County Hospital NHS Foundation Trust
City only
Guildford, England

Common questions

Does the robot operate on me by itself?

No. The robot is purely a tool. Your surgeon remains in full control the entire time, guiding the robotic arms from a console in the operating theatre.

What happens if the robot cannot remove all the cancer?

Patient safety is the top priority. If the surgeon finds that the cancer cannot be completely removed using the robot, they will immediately switch to traditional open surgery.

Do I have to take part in the glowing dye test?

No. The dye test is completely optional. You can join the main robotic surgery study without participating in the dye part.

Will taking part delay my future cancer treatment?

No. The operation is timed as part of your normal treatment schedule, and healing faster from smaller cuts may actually help you stay on track for further chemotherapy.

Where does the surgery take place?

The study takes place at the Royal Surrey NHS Foundation Trust in Guildford, which has the most experience with robotic gynaecological surgery in the UK.

How to find out more

Christina Uwins

christina.uwins@nhs.net +44 (0)7958143884 Official trial record

Always speak to your GP or specialist before deciding to take part in a study.