This thesis centres on the development and justification of the MIRRORS Study (Minimally Invasive Robotic surgery, Role in optimal debulking Ovarian cancer, Recovery & Survival). Minimally invasive surgery is the gold standard for uterine cancer due to its proven benefits of reduced morbidity, quicker recovery and shorter length of stay. The introduction of the Da Vinci robot at our centre significantly improved outcomes in uterine cancer, enabling over 90% of patients to undergo minimally invasive surgery regardless of age or BMI. This resulted in enhanced recovery and improved hospital efficiency.

The evidence supporting the safety of robotic surgery in advanced ovarian cancer remains uncertain. A

randomised controlled trial is required to determine this. The MIRRORS trial aimed to establish the feasibility and safety of robotic interval debulking surgery following the MIRRORS protocol (robot-assisted laparoscopic assessment prior to robotic or open surgery) in women with advanced-stage ovarian cancer.

The use of indocyanine green (ICG), to identify metastatic deposits during robotic interval debulking showed limited clinical value in patients with extensive disease, however, showed some promise in women with an excellent response to chemotherapy where few tumour deposits remained. (MIRRORS ICG)

The MIRRORS Survey highlighted the need for improved education of patients, healthcare providers and

laypersons, to dispel myths regarding robotic surgery. The survey findings have directly influenced the

ongoing development of our final planned trial “MIRRORS RCT” an international multicentre randomised

controlled trial aiming to determine whether Robotic interval debulking surgery, following the MIRRORS

Protocol, is non-inferior to standard open interval debulking surgery in terms of overall and progression-free survival.

MIRRORS is the first of three planned trials: MIRRORS, MIRRORS-RCT (pilot), and MIRRORS-RCT. If robotic interval debulking surgery proves to be non-inferior to open interval debulking surgery, a significant change in practice could result.