Role of minimally invasive surgery in gynecologic malignancies

Minimally invasive surgery (MIS) is practiced by more than 90% of gynecologic oncologists. Knowledge of anatomy, the disease process, and surgical technique is key during these complicated surgical procedures. Several studies have shown that 10 to 20 cases are needed to gain proficiency with a certain procedure. MIS reduces blood loss, transfusions, length of hospital stay, and wound complications without compromising adequacy of the procedure or staging even in (extremely) morbidly obese patients. Survival outcomes for endometrial and ovarian cancer are similar after MIS and laparotomy, while survival outcomes with MIS have been shown to be worse for cervical cancer. Several safe methods exist to extract an enlarged uterus after MIS. Morcellation is not recommended when there is suspicion or proven preinvasive or invasive disease. Laparoscopy can be used in ovarian cancer to assess the extent of disease and chance of complete debulking surgery. MIS in advanced or recurrent ovarian cancer and its utilization in interval debulking is still under investigation, and prospective trials to confirm safety and feasibility are ongoing.