Laparoscopic surgery in gynaecological oncology.
AIMS: The use of laparoscopic staging and/or surgery in the field of gynaecological oncology was pioneered in the late 1980s and the first reports were published in the early 1990s. The issue has been initially most controversial, and is still debated, with some justification considering the possible adverse consequences of surgical mismanagement of gynaecologic malignancy. METHODS: The current literature has been reviewed and updated, concentrating on long-term, and/or comparative studies. Large observational studies have also been included. Recent papers concerning new developments have been selected. FINDINGS: A number of papers have confirmed the absence of significant adverse effects on survival after laparoscopic diagnosis or surgery in gynaecological cancers. New developments cover virtually all the basic techniques in cancer surgery, including major exenterative surgery. The use of extraperitoneal technique for aortic dissections is emerging as a new tool. New indications, such as radical vaginal trachelectomy, radical parametrectomy, pelvic sentinel node identification, interval debulking surgery of adnexal malignancies, or the use of pretherapeutic surgical staging of uterine cancers, have been developed in direct relation with the use of laparoscopic techniques. CONCLUSIONS: Current available data and worldwide interest clearly demonstrate that laparoscopic techniques must now be part of the armamentarium of the gynaecologic oncologist. Postoperative morbidity and recurrence risk do not seem to be affected. Cost-efficiency of laparoscopic procedures is based on the reduction of hospital stay and recovery time, although operating room time is increased in some procedures. Combined training in gynaecologic oncology and in laparoscopic and/or vaginal surgery is more than ever mandatory to avoid the risk of inadequate staging or management of pelvic malignancies.