Innovative laparoscopic surgery in gynecologic oncology

Abstract

Minimally invasive surgery has been performed since the early 1990s, and gynecologic oncology surgeons continue to improve their skills for this procedure. Advanced laparoscopic techniques are used to evaluate and treat cervical, endometrial, and ovarian malignancies. Laparoscopy has significant benefits in selected oncologic patients and may be a more useful technique than the abdominal approach. The benefits of laparoscopy include less postoperative pain, less blood loss, shorter length of hospital stay, and a shorter recovery period with no significant increase in complications or morbidity. With emerging data, it appears that the risk of cancer recurrence does not increase with a minimally invasive approach. The incorporation of laparoscopic pelvic and para-aortic lymphadenectomy has expanded the types of procedures performed for the management of certain gynecologic malignancies. New techniques, including hand-assisted laparoscopic procedures and extraperitoneal lymph node dissections, are expanding the role of laparoscopy in the treatment of all gynecologic malignancies.

Chylous ascites after lymphadenectomy for gynecological malignancies

“…Para‐aortic and/or pelvic lymphadenectomy in the treatment of gynecologic malignancies have been identified as potential causes for chylous ascites, among others . The laparoscopic approach for pelvic and para‐aortic lymphadenectomy has become established in recent years in addition to the traditional open surgical approach . Symptoms of chylous ascites are milky‐white fluid in the routinely used abdominal drain, or distension of the abdomen after drawing of the abdominal drain, as well as loss of large amounts of vaginal fluids after hysterectomy in patients with a permeable vaginal suture .…”

Vaginal morcellation: A new strategy for large gynecological malignant tumor extraction

“…The patients remained hospitalized for about 2.3 days [1][2][3]. In spite of the fact that the mean follow-up time is limited to 3 months [1][2][3][4][5], all patients are without evidence of local or distant recurrence. Data concerning the operative outcomes of the patients with uterine cancer are shown in Table 2.…”

“…Nevertheless, a number of publications have demonstrated no difference in survival among patients laparoscopically or conventionally operated, since some standard surgical principles are respected [1,4,5].…”

Risk factors for robotic gynecologic procedures requiring conversion to other surgical procedures

“…Minimally invasive surgery has been increasingly utilized in the field of gynecology in recent decades. Minimally invasive techniques confer many benefits, including a shorter duration of hospital admission, a faster recovery and return to daily activities, lower intraoperative blood loss, and reduced postoperative pain [1][2][3]. During the last 10 years, the use of robotic-assisted surgery has substantially increased, beginning with urologic procedures, before expanding to include gynecologic surgery and other specialties [4].…”