Laparoscopic surgery for gynaecological cancers in obese women

The use of laparoscopic surgery in the management of gynaecological malignancies has been growing for over a decade. Concomitantly the incidence of obesity has been increasing worldwide. This review summarizes the available studies on minimal invasive surgery in obese women with gynaecological malignancies. We undertook a literature search to identify the differences between traditional open methods and the laparoscopic approach in terms of intra- and postoperative outcome and patient safety. Only eight relevant studies were identified. Six of these focused on endometrial cancer, one study included early stage cervical and ovarian cancers with other benign conditions, while another paper included cervical and endometrial pre-cancers and only a few malignant conditions. Obesity is generally known to increase the risk of intra- and postoperative complications. However, several studies show that obesity, formerly precluding keyhole surgery, seems now to be an indication for the laparoscopic approach. As compared to laparotomy, laparoscopic surgery has a good postoperative outcome, reduced estimated blood loss (EBL) and pain and in some series an increased lymph node count. Laparoscopy has been shown to be cost effective with a shorter hospital stay and return to normal activity. Survival is reported to be the same with both laparotomy and laparoscopy. The benefits of minimal invasive surgery in gynaecological surgery are starting to be found with robotic surgery.