Minimally Invasive Surgery in Gynecologic Oncology

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.

Ovarian Cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology

“…123,127 In select patients, minimally invasive procedures may be used to assess whether cytoreductive surgery is feasible and to achieve cytoreduction. 110,[128][129][130][131] For young patients who will abruptly enter menopause after surgery, various supportive care measures may be used to help decrease hot flashes and other symptoms. [132][133][134] Procedures that may be considered for optimal surgical cytoreduction (in all stages) include radical pelvic dissection, bowel resection and/or appendectomy, diaphragm or other peritoneal surface stripping, splenectomy, partial hepatectomy, partial gastrectomy, or partial cystectomy and/or ureteroneocystostomy, cholecystectomy, and/or distal pancreatectomy.…”

Implementation of a restrictive blood transfusion protocol in a gynecologic oncology service

“…Evolving surgical techniques are another possible explanation accounting for improved morbidity during the study period. For example, it is well established that minimally invasive surgery compared to laparotomy results in shorter hospital stays, reductions in postoperative morbidity as well as blood transfusion rates according to many studies [17][18][19][20]. However, there were no changes in surgical faculty during the study period and minimally invasive surgical volume did not markedly change.…”

Single-incision laparoscopic surgery (SILS), radical hysterectomy for early stage cervical cancer, a case report and review of literature

“…11 Minimally invasive gynecological procedures have been associated with a shorter hospital stay and improved outcomes such as less post-operative complications and improved pain control. 4,6,12 SILS utilizes one incision in the umbilicus reducing the amount of abdominal incisions needed for the procedure. All instruments are introduced through the single incision utilizing a device, which allows for maintaining abdominal insufflation.…”