Abstract
The standard treatment of ovarian cancer includes upfront surgery with intent to accurately diagnose and stage the disease and to perform maximal cytoreduction, followed by chemotherapy in most cases. Surgical staging of ovarian cancer traditionally hasincludedexploratorylaparotomywithperitonealwashings,hysterectomy,salpingo-oophorectomy,omentectomy,multiple peritonealbiopsies,andpossiblepelvicandpara-aorticlymphadenectomy.Intheearly1990s,pioneersinlaparoscopicsurgery used minimally invasive techniques to treat gynecologic cancers, including laparoscopic staging of early ovarian cancer and primary and secondary cytoreduction in advanced and recurrent disease in selected cases. Since then, the role of minimally invasive surgery in gynecologic oncology has been continually expanding, and today advanced laparoscopic and robotic- assisted laparoscopic techniques are used to evaluate and treat cervical and endometrial cancer. However, the important ques- tion about the place of the minimally invasive approach in surgical treatment of ovarian cancer remains to be evaluated and answered. Overall, thepotential roleof minimallyinvasive surgeryin treatment ofovarian cancer isas follows:i)laparoscopic evaluation,diagnosis,andstagingofapparentearlyovariancancer;ii)laparoscopicassessmentoffeasibilityofupfrontsurgical cytoreduction to no visible disease; iii) laparoscopic debulking of advanced ovarian cancer; iv) laparoscopic reassessment in patients with complete remission after primary treatment; and v) laparoscopic assessment and cytoreduction of recurrent dis- ease. The accurate diagnosis of suspect adnexal masses, the safety and feasibility of this surgical approach in early ovarian cancer, the promise of laparoscopy as the most accurate tool for triaging patients with advanced disease for surgery vs upfront chemotherapy or neoadjuvant chemotherapy, and its potential in treatment of advanced cancer have been documented and therefore should be incorporated in the surgical methods of every gynecologic oncology unit and in the training programs in gynecologic oncology. Journal of Minimally Invasive Gynecology (2013) 20, 754-765 2013 AAGL. All rights reserved.
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