Laparoscopy in gynaecological oncological surgery in 2005

Laparoscopy entered the field of gynaecology in the mid-1950s, but the technique was slow to evolve until the beginning of the 1990s, when it became more widely applied in gynecological oncology. Although few trials have looked at the safety of laparoscopy in oncology, it is now widely used for most gynaecological malignancies. Cervical cancer has probably the strongest literature devoted to it, and so far this does not seem to demonstrate a detrimental survival profile. Uterine cancer relies on laparoscopy for the initial surgery or staging of an unstaged patient. In ovarian cancer, the technique is mostly used in early cases for staging purposes, or in advanced cases before neoadjuvant chemotherapy. Trocar metastasis is probably not as frequent as initially suggested, but good surgical technique is of paramount importance in preventing this. Although laparoscopy is very promising and probably oncologically safe, and although there are few published prospective trials, the technique demands satisfactory additional training and, in the setting of gynaecological cancers, should be reserved for trained subspecialists.