Laparoscopy in Gynaecological Oncology Issues and Present Status

Use of laparoscopy for diagnosis and treatment of gynaecological malignancy is here to stay. What may have seemed mission impossible a few years ago has today become possible. The advantages of the minimal access approach of greater precision from the magnification afforded on the video screen, significantly less morbidity, early mobilization and recovery are incentives enough for both gynae onco-surgeons and patients to opt for this approach. Added to this in cancer patients is the significant advantage of being able to start postoperative chemotherapy or radiotherapy if earlier indicated – within a week of laparoscopy versus 2–3 weeks of wait required after traditional abdominal surgery.In patients with cervical and endometrial cancers, the use of laparoscopic approach for pelvic and para-aortic lymphadenectomy is combined with either a laparoscopic, a vaginal hysterectomy or trachelectomy as appropriate.The laparoscopic removal of adnexal masses unlikely to be malignant, in an endobag, has become almost the gold standard of treatment. However, in the case of ovarian malignancy diagnosed during or after a laparoscopic procedure or with tumor spillage an immediate/early staging procedure becomes mandatory. The current status of laparoscopic approach in ovarian cancer is not yet established for staging of early stage ovarian disease, for the procedure of second look operation and for cytoreductive surgery in advanced cancer. This is because of the immense complexity of the procedure and the problems of feasibility with performing adequate surgery. In addition, there is a lack of trials comparing its outcome to the standard approach. It is only a matter of time that this too will become a reality with increasing expertise and improved technology.For the skeptics of laparoscopic surgery, the lengthy operating time is a criticism. However, with the safety of current anaesthetic techniques, this is not a major issue. What remains of concern is the problem of port-site metastasis seen in a small percentage of patients associated with the laparoscopic approach. Various measures are being used to decrease this risk.The most important factor in surgery is not the extent of the incision or the device, but rather the surgical expertise and judgement as far as the gynaecologists is concerned. For the patient, however the emphasis and concern after reduction in mortality is reduction in morbidity and improvement of quality of life. Laparoscopic surgery does just that.