Minimally Invasive Surgery in Gynecologic Oncology: A Review of Modalities and the Literature

Abstract

Minimally invasive surgery is one of the newest and most exciting areas of development in procedural medicine. This field shows tremendous potential to increase therapeutic benefit while minimizing some of the painful or dangerous side effects of surgical interventions. Minimally invasive surgery has strong historic ties to the field of gynecology and has come a long way as technology and techniques have improved. This has increasingly allowed the application of laparoscopy to more complex procedures and the treatment of gynecologic malignancies. Three laparoscopic approaches, traditional laparoscopy, robotic assisted laparoscopy and laparoendoscopic single-site surgery are reviewed here. We discuss the basic approaches to these three laparoscopic techniques, and then review their applications in gynecologic oncology. We also touch on the evidence behind outcomes associated with their use.

Oncologic Concerns regarding Laparoscopic Cytoreductive Surgery in Patients with Advanced Ovarian Cancer Submitted to Neoadjuvant Chemotherapy

“…It may significantly reduce procedure-related morbidity and expedite recovery especially in this patient population [9]. In addition, image magnification, improved dissection in critical areas, the possibility of performing concomitant procedures, a shorter hospital stay, reduced blood loss, a reduction in the need for postoperative analgesics, and earlier initiation of adjuvant therapies are further advantages of the endoscopic techniques [9,10,13]. On the other hand, several important oncologic concerns have limited the widespread use of laparoscopy especially in ovarian cancer surgery.…”

Survey of current practices and opinions of German Society of Gynecologic Endoscopy members regarding the treatment of ovarian neoplasia by robotic surgery

“…The benefits of MIS include reduced postoperative pain intensity, wound infection rates, length of hospitalization, and procedure-associated morbidity, as well as the possibility of immediate adjuvant therapy initiation. These advantages have led to the gradual implementation of laparoscopy and robotic surgery as alternatives to open surgery for the treatment of certain gynecologic malignancies [ 6 ]. Major concerns about MIS use in the gynecological context, however, are related to the ability to achieve sufficient oncological safety; they include the risks of intraoperative tumor rupture, port site metastasis, and peritoneal dissemination of tumor cells, as well as the questionable efficacy of surgical staging, which have prevented an implementation of laparoscopy and robotic surgery for the treatment of ovarian cancer [ 7 – 9 ].…”

Single-site robotic surgery in gynecologic cancer: a pilot study

“…Single-incision and single-port surgeries have recently become the preferred surgical methods, involving less blood loss, shorter hospital stays, and improved recovery time [ 8 ]. However, there are limitations to these techniques including poor ergonomics and loss of triangulation.…”