Abstract
Minimally invasive surgery has been utilized in the field of obstetrics and gynecology as far back as the 1940s when culdoscopy was first introduced as a visualization tool. Gynecologists then began to employ minimally invasive surgery for adhesiolysis and obtaining biopsies but then expanded its use to include procedures such as tubal sterilization (Clyman (1963), L. E. Smale and M. L. Smale (1973), Thompson and Wheeless (1971), Peterson and Behrman (1971)). With advances in instrumentation, the first laparoscopic hysterectomy was successfully performed in 1989 by Reich et al. At the same time, minimally invasive surgery in gynecologic oncology was being developed alongside its benign counterpart. In the 1975s, Rosenoff et al. reported using peritoneoscopy for pretreatment evaluation in ovarian cancer, and Spinelli et al. reported on using laparoscopy for the staging of ovarian cancer. In 1993, Nichols used operative laparoscopy to perform pelvic lymphadenectomy in cervical cancer patients. The initial goals of minimally invasive surgery, not dissimilar to those of modern medicine, were to decrease the morbidity and mortality associated with surgery and therefore improve patient outcomes and patient satisfaction. This review will summarize the history and use of minimally invasive surgery in gynecologic oncology and also highlight new minimally invasive surgical approaches currently in development.
Highlights
Laparoscopy in Cervical CancerThere was no significant difference observed when the patients were divided into those with ≤2 cm tumors and those with >2 cm tumors, or when analyzed by age ≤46 years versus >46 years, tumor histology, and risk for recurrence [7]
Li et al reported on a retrospective review of 35 open radical hysterectomies and 90 laparoscopy radical hysterectomies and looked at recurrence rates
Nam et al reviewed 263 cases of laparoscopic radical hysterectomy that were matched 1 : 1 with cases performed via laparotomy and found significant differences between the two groups in terms of EBL and hospital stay
Summary
There was no significant difference observed when the patients were divided into those with ≤2 cm tumors and those with >2 cm tumors, or when analyzed by age ≤46 years versus >46 years, tumor histology, and risk for recurrence [7] From these studies we can conclude that a laparoscopic approach to radical hysterectomy for the treatment of cervical cancer is feasible and safe with less postoperative morbidity. There was 1 recurrence of adenocarcinoma 14 months posttrachelectomy that was treated with 3 cycles of cisplatin and paclitaxel and subsequent hysterectomy and radiation for eventual no evidence of disease status [14] When comparing these laparoscopic cases to trachelectomies performed via a vaginal approach, it appears that there is no difference in recurrence or pregnancy rates. From the previous data we can conclude that a laparoscopic approach to trachelectomies for cervical cancer is a feasible option
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