%0 Journal Article
%T Minimally Invasive Surgery in Gynecologic Oncology
%A Kristina M. Mori
%A Nikki L. Neubauer
%J ISRN Obstetrics and Gynecology
%D 2013
%R 10.1155/2013/312982
%X Minimally invasive surgery has been utilized in the field of obstetrics and gynecology as far back as the 1940s when culdoscopy was first introduced as a visualization tool. Gynecologists then began to employ minimally invasive surgery for adhesiolysis and obtaining biopsies but then expanded its use to include procedures such as tubal sterilization (Clyman (1963), L. E. Smale and M. L. Smale (1973), Thompson and Wheeless (1971), Peterson and Behrman (1971)). With advances in instrumentation, the first laparoscopic hysterectomy was successfully performed in 1989 by Reich et al. At the same time, minimally invasive surgery in gynecologic oncology was being developed alongside its benign counterpart. In the 1975s, Rosenoff et al. reported using peritoneoscopy for pretreatment evaluation in ovarian cancer, and Spinelli et al. reported on using laparoscopy for the staging of ovarian cancer. In 1993, Nichols used operative laparoscopy to perform pelvic lymphadenectomy in cervical cancer patients. The initial goals of minimally invasive surgery, not dissimilar to those of modern medicine, were to decrease the morbidity and mortality associated with surgery and therefore improve patient outcomes and patient satisfaction. This review will summarize the history and use of minimally invasive surgery in gynecologic oncology and also highlight new minimally invasive surgical approaches currently in development. 1. Laparoscopy in Cervical Cancer 1.1. Radical Hysterectomy Laparoscopic surgery has played a role in the treatment of cervical cancer since the late 1980s. Nichols reported on laparoscopic lymphadenectomy for cervical cancer in 1993, over 30 years ago [1]. The laparoscopic radical hysterectomy with pelvic and para-aortic lymph node dissection was then first reported by Nezhat et al. a few years later [2]. When compared to the traditional radical hysterectomy performed via laparotomy, the laparoscopic approach allows for less blood loss and a shorter hospital stay at the cost of slightly increased procedure times. A retrospective study from Memorial Sloan Kettering compared 195 laparotomy patients to 17 laparoscopy patients undergoing radical hysterectomy. In this study, there was no significant difference between mean pelvic lymph node count (30.7 versus 25.5), transfusion rate (21 versus 5.3%), or negative surgical margins (5.1 versus 0%). The mean operating room times (296 versus 371 minutes, ), mean EBL (693 versus 391£żmL, ), and mean length of hospital stay (9.7 versus 4.5 days, ) were significantly different with a lower EBL and shorter hospital stay
%U http://www.hindawi.com/journals/isrn.obgyn/2013/312982/