Laparoscopic surgery for gynecologic cancer

Operative laparoscopy is an alternative to laparotomy for most gynecologic surgical procedures, but its role in gynecologic oncology has been considered only recently. Laparoscopy has been applied to gynecologic cancer with good results. Advantages include better visualization of the abdominal cavity and more rapid recovery, allowing earlier initiation of either chemotherapy or radiotherapy. Concerns include the risk for dissemination of neoplastic disease if less radical surgery is performed. With improvements in technology and advanced clinical experience, laparoscopic radical surgery can be performed with adequate tissue margins, conforming to accepted guidelines. Further, studies have shown that the yield of pelvic nodes significantly increases with experience. The danger of abdominal wall tumor implantation after laparoscopy for malignant conditions should be considered, but is infrequent. Careful techniques and the use of a laparoscopic pouch can prevent peritoneal dissemination and protect the abdominal wall. By cooperating closely, the surgical team and oncologists can offer the cancer patient optimal management with the lower morbidity and rapid recovery associated with laparoscopic surgery. However, follow-up studies are needed to determine the long-term survival following operative laparoscopy.