Operative laparoscopy in gynaecological oncology

Initial reports on the role of laparoscopy in gynaecological malignancies have centred around staging procedures. Laparoscopic lymphadenectomy, both pelvic and para-aortic, appears to be feasible and adequate. It appears that laparoscopy may play an important role in reviving the radical vaginal hysterectomy for patients with early cervical cancer. Similarly, an abdominal incision may be avoided in patients with early endometrial carcinoma by employing laparoscopic staging with vaginal hysterectomy. The role laparoscopy will play in ovarian cancer is still to be defined, and laparoscopic advocates must be cautious in this subset of patients. However, for those gynaecological oncologists employing second-look procedures, it appears that beginning with laparoscopy may make laparotomy unnecessary in the majority of patients. Survival data for patients with gynaecological malignancies managed using laparoscopy in lieu of laparotomy are still lacking. It is imperative that survival is not compromised by employing a new surgical technique. Cost data comparing laparoscopy to laparotomy in our subspeciality is unavailable. This increasingly important aspect of medical care may influence the future of laparoscopy. These and other important issues need to be addressed by future trials before the role of laparoscopy in gynaecological oncology can be determined.