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MIRRORS: a prospective cohort study assessing the feasibility of robotic interval debulking surgery for advanced-stage ovarian cancer.

Uwins, Christina; Assalaarachchi, Hasanthi; Bennett, Kate; Read, James; Tailor, Anil; Crawshaw, James; Chatterjee, Jayanta; Ellis, Patricia; Skene, Simon S.; Michael, Agnieszka; Butler-Manuel, Simon


Christina Uwins

Hasanthi Assalaarachchi

Kate Bennett

James Read

Anil Tailor

James Crawshaw

Jayanta Chatterjee

Patricia Ellis

Simon S. Skene

Agnieszka Michael

Simon Butler-Manuel


The object of this research was 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. MIRRORS is the first of three planned trials: MIRRORS, MIRRORS-RCT (pilot), and MIRRORS-RCT. The participants were patients with stage IIIc-IVb epithelial ovarian cancer undergoing neo-adjuvant chemotherapy, suitable for interval debulking surgery with a pelvic mass ≤8 cm. The intervention was robot-assisted laparoscopic assessment prior to robotic or open interval debulking surgery (MIRRORS protocol). The primary outcome was feasibility of recruitment, and the secondary outcomes were quality of life (EORTC QLQC30/OV28, HADS questionnaires), pain, surgical complications, complete cytoreduction rate (%), conversion to open surgery (%), and overall and progression-free survival at 1 year. Overall, 95.8% (23/24) of patients who were eligible were recruited. Median age was 68 years (range 53–83). All patients had high grade serous histology and were BRCA negative. In total, 56.5% were stage IV, 43.5% were stage III, 87.0% had a partial response, while 13.0% had stable disease by RECIST 1.1. Median peritoneal cancer index was 24 (range 6–38). Following MIRRORS protocol, 87.0% (20/23) underwent robotic interval debulking surgery, and 13.0% (3/23) had open surgery. All patients achieved R<1 (robotic R0=47.4%, open R0=0%). No patients had conversion to open. Median estimated blood loss was 50 mL for robotic (range 20–500 mL), 2026 mL for open (range 2000–2800 mL) (p=0.001). Median intensive care length of stay was 0 days for robotic (range 0–8) and 3 days (range 3–13) for MIRRORS Open (p=0.012). The median length of stay was 1.5 days for robotic (range 1–17), 6 days for open (range 5–41) (p=0.012). The time to chemotherapy was as follows 18.5 days for robotic (range 13–28), 25 days for open (range 22–28) (p=0.139). Robotic interval debulking surgery appears safe and feasible for experienced robotic surgeons in patients with a pelvic mass ≤8 cm. A randomized controlled trial (MIRRORS-RCT) will determine whether MIRRORS protocol has non-inferior survival (overall and progression-free) compared with open interval debulking surgery.


UWINS, C., ASSALAARACHCHI, H., BENNETT, K., READ, J., TAILOR, A., CRAWSHAW, J., CHATTERJEE, J., ELLIS, P., SKENE, S.S., MICHAEL, A. and BUTLER-MANUEL, S. 2024. MIRRORS: a prospective cohort study assessing the feasibility of robotic interval debulking surgery for advanced-stage ovarian cancer. International journal of gynecological cancer [online], 34(6), pages 886-897. Available from:

Journal Article Type Article
Acceptance Date Mar 12, 2024
Online Publication Date Apr 1, 2024
Publication Date Jun 30, 2024
Deposit Date Jun 11, 2024
Publicly Available Date Jun 11, 2024
Journal International journal of gynecological cancer
Print ISSN 1048-891X
Electronic ISSN 1525-1438
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 34
Issue 6
Pages 886-897
Keywords Robot-assisted surgery; Ovarian cancer; Robotic interval debulking surgeries; Randomized controlled trials
Public URL
Additional Information This article has been published with separate supporting information. This supporting information has been incorporated into a single file on this repository and can be found at the end of the file associated with this output.


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