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？mL, ), and mean length of hospital stay (9.7 versus 4.5 days, ) were significantly different with a lower EBL and shorter hospital stay
References
[1]
D. H. Nichols, Gynecologic and Obstetric Surgery, Mosby, St. Louis, Mo, USA, 1993.
[2]
C. R. Nezhat, M. O. Burrell, F. R. Nezhat, B. B. Benigno, and C. E. Welander, “Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection,” American Journal of Obstetrics and Gynecology, vol. 166, no. 3, pp. 864–865, 1992.
[3]
N. R. Abu-Rustum, M. L. Gemignani, K. Moore et al., “Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using the argon-beam coagulator: pilot data and comparison to laparotomy,” Gynecologic Oncology, vol. 91, no. 2, pp. 402–409, 2003.
[4]
M. Frumovitz, R. dos Reis, C. C. Sun et al., “Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer,” Obstetrics and Gynecology, vol. 110, no. 1, pp. 96–102, 2007.
[5]
J. D. Wright, T. J. Herzog, A. I. Neugut et al., “Comparative effectiveness of minimally invasive and abdominal radical hysterectomy for cervical cancer,” Gynecologic Oncology, vol. 127, no. 1, pp. 11–17, 2012.
[6]
G. Li, X. Yan, H. Shang, G. Wang, L. Chen, and Y. Han, “A comparison of laparoscopic radical hysterectomy and pelvic lymphadenectomy and laparotomy in the treatment of Ib-IIa cervical cancer,” Gynecologic Oncology, vol. 105, no. 1, pp. 176–180, 2007.
[7]
J.-H. Nam, J.-Y. Park, D.-Y. Kim, J.-H. Kim, Y.-M. Kim, and Y.-T. Kim, “Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study,” Annals of Oncology, vol. 23, no. 4, pp. 903–911, 2012.
[8]
D. D'Argent, J. L. Brun, M. Roy, and I. Remi, “Pregnancies following radical trachelectomy for invasive surgical cancer,” Gynecologic Oncology, vol. 52, article 105, 1994.
[9]
C.-L. Lee, K.-G. Huang, C.-J. Wang, C.-F. Yen, and C.-H. Lai, “Laparoscopic radical trachelectomy for stage Ib1 cervical cancer,” Journal of the American Association of Gynecologic Laparoscopists, vol. 10, no. 1, pp. 111–115, 2003.
[10]
J. B. Schlaerth, N. M. Spirtos, and A. C. Schlaerth, “Radical trachelectomy and pelvic lymphadenectomy with uterine preservation in the treatment of cervical cancer,” American Journal of Obstetrics and Gynecology, vol. 188, no. 1, pp. 29–34, 2003.
[11]
D. Cibula, L. Ungár, L. Pálfalvi, B. Binó, and D. Kuzel, “Laparoscopic abdominal radical trachelectomy,” Gynecologic Oncology, vol. 97, no. 2, pp. 707–709, 2005.
[12]
N. Y. Park, G. O. Chong, Y. L. Cho, I. S. Park, and Y. S. Lee, “Total laparoscopic nerve-sparing radical trachelectomy,” Journal of Laparoendoscopic and Advanced Surgical Techniques, vol. 19, no. 1, pp. 53–58, 2009.
[13]
J.-H. Kim, J.-Y. Park, D.-Y. Kim, Y.-M. Kim, Y.-T. Kim, and J.-H. Nam, “Fertility-sparing laparoscopic radical trachelectomy for young women with early stage cervical cancer,” BJOG, vol. 117, no. 3, pp. 340–347, 2010.
[14]
A. Martin and A. Torrent, “Laparoscopic nerve-sparing radical trachelectomy: surgical technique and outcome,” Journal of Minimally Invasive Gynecology, vol. 17, no. 1, pp. 37–41, 2010.
[15]
J. L. Walker, M. R. Piedmonte, N. M. Spirtos et al., “Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2,” Journal of Clinical Oncology, vol. 27, no. 32, pp. 5331–5336, 2009.
[16]
J. L. Walker, M. R. Piedmonte, N. M. Spirtos et al., “Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 study,” Journal of Clinical Oncology, vol. 30, no. 7, pp. 695–700, 2012.
[17]
K. Galaal, A. Bryant, A. D. Fisher, M. Al-Khaduri, F. Kew, and A. D. Lopes, “Laparoscopy versus laparotomy for the management of early stage endometrial cancer,” Cochrane Database of Systematic Reviews, vol. 9, Article ID CD006655, 2012.
[18]
D. S. Chi, N. R. Abu-Rustum, Y. Sonoda et al., “The safety and efficacy of laparoscopic surgical staging of apparent stage I ovarian and fallopian tube cancers,” American Journal of Obstetrics and Gynecology, vol. 192, no. 5, pp. 1614–1619, 2005.
[19]
J.-Y. Park, J. Bae, M. C. Lim et al., “Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety,” International Journal of Gynecological Cancer, vol. 18, no. 6, pp. 1202–1209, 2008.
[20]
F. R. Nezhat, S. M. Denoble, C. S. Liu et al., “The safety and efficacy of laparoscopic surgical staging and debulking of apparent advanced stage ovarian, fallopian tube, and primary peritoneal cancers,” Journal of the Society of Laparoendoscopic Surgeons, vol. 14, no. 2, pp. 155–168, 2010.
[21]
M. P. Lowe, D. H. Chamberlain, S. A. Kamelle, P. R. Johnson, and T. D. Tillmanns, “A multi-institutional experience with robotic-assisted radical hysterectomy for early stage cervical cancer,” Gynecologic Oncology, vol. 113, no. 2, pp. 191–194, 2009.
[22]
L. A. Cantrell, A. Mendivil, P. A. Gehrig, and J. F. Boggess, “Survival outcomes for women undergoing type III robotic radical hysterectomy for cervical cancer: a 3-year experience,” Gynecologic Oncology, vol. 117, no. 2, pp. 260–265, 2010.
[23]
P. Geetha and M. K. Nair, “Laparoscopic, robotic and open method of radical hysterectomy for cervical cancer: a systematic review,” Journal of Minimal Access Surgery, vol. 8, no. 3, pp. 67–73, 2012.
[24]
L. T. Chuang, D. L. Lerner, C. S. Liu, and F. R. Nezhat, “Fertility-sparing robotic-assisted radical trachelectomy and bilateral pelvic lymphadenectomy in early-stage cervical cancer,” Journal of Minimally Invasive Gynecology, vol. 15, no. 6, pp. 767–770, 2008.
[25]
J. Persson, P. Kannisto, and T. Bossmar, “Robot-assisted abdominal laparoscopic radical trachelectomy,” Gynecologic Oncology, vol. 111, no. 3, pp. 564–567, 2008.
[26]
J. P. Geisler, C. J. Orr, and K. J. Manahan, “Robotically assisted total laparoscopic radical trachelectomy for fertility sparing in stage IB1 adenosarcoma of the cervix,” Journal of Laparoendoscopic and Advanced Surgical Techniques, vol. 18, no. 5, pp. 727–729, 2008.
[27]
P. T. Ramirez, K. M. Schmeler, A. Malpica, and P. T. Soliman, “Safety and feasibility of robotic radical trachelectomy in patients with early-stage cervical cancer,” Gynecologic Oncology, vol. 116, no. 3, pp. 512–515, 2010.
[28]
A. F. Burnett, P. J. Stone, L. A. Duckworth, and J. J. Roman, “Robotic radical trachelectomy for preservation of fertility in early cervical cancer: case series and description of technique,” Journal of Minimally Invasive Gynecology, vol. 16, no. 5, pp. 569–572, 2009.
[29]
D. G. Hong, Y. S. Lee, N. Y. Park, G. O. Chong, S. Park, and Y. L. Cho, “Robotic uterine artery preservation and nerve-Sparing radical trachelectomy with bilateral pelvic lymphadenectomy in early-Stage cervical cancer,” International Journal of Gynecological Cancer, vol. 21, no. 2, pp. 391–396, 2011.
[30]
J. Persson, S. Imboden, P. Reynisson, B. Andersson, C. Borgfeldt, and T. Bossmar, “Reproducibility and accuracy of robot-assisted laparoscopic fertility sparing radical trachelectomy,” Gynecologic Oncology, vol. 127, no. 3, pp. 484–488, 2012.
[31]
R. R. Barakat, M. Markman, and M. E. Randall, Principles and Practice of Gynecologic Oncology, Lippincott Williams & Wilkins, 5th edition, 2009.
[32]
P. C. W. Lim, “Robotic assisted total pelvic exenteration: a case report,” Gynecologic Oncology, vol. 115, no. 2, pp. 310–311, 2009.
[33]
E. Lambaudie, F. Narducci, E. Leblanc, M. Bannier, and G. Houvenaeghel, “Robotically-assisted laparoscopic anterior pelvic exenteration for recurrent cervical cancer: report of three first cases,” Gynecologic Oncology, vol. 116, no. 3, pp. 582–583, 2010.
[34]
M.-A. Davis, S. Adams, D. Eun, D. Lee, and T. C. Randall, “Robotic-assisted laparoscopic exenteration in recurrent cervical cancer. Robotics improved the surgical experience for 2 women with recurrent cervical cancer,” American Journal of Obstetrics and Gynecology, vol. 202, no. 6, p. 663.e1, 2010.
[35]
M. P. Lowe, P. R. Johnson, S. A. Kamelle, S. Kumar, D. H. Chamberlain, and T. D. Tillmanns, “A multiinstitutional experience with robotic-assisted hysterectomy with staging for endometrial cancer,” Obstetrics and Gynecology, vol. 114, no. 2, part 1, pp. 236–243, 2009.
[36]
G. Gaia, R. W. Holloway, L. Santoro, S. Ahmad, E. Di Silverio, and A. Spinillo, “Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review,” Obstetrics and Gynecology, vol. 116, no. 6, pp. 1422–1431, 2010.
[37]
A. Subramaniam, K. H. Kim, S. A. Bryant et al., “A cohort study evaluating robotic versus laparotomy surgical outcomes of obese women with endometrial carcinoma,” Gynecologic Oncology, vol. 122, no. 3, pp. 604–607, 2011.
[38]
P. A. Gehrig, L. A. Cantrell, A. Shafer, L. N. Abaid, A. Mendivil, and J. F. Boggess, “What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman?” Gynecologic Oncology, vol. 111, no. 1, pp. 41–45, 2008.
[39]
F. J. Backes, L. A. Brudie, M. R. Farrell et al., “Short- and long-term morbidity and outcomes after robotic surgery for comprehensive endometrial cancer staging,” Gynecologic Oncology, vol. 125, no. 3, pp. 546–551, 2012.
[40]
L. A. Brudie, F. J. Backes, S. Ahmad, et al., “Analysis of disease recurrence and survival for women with uterine malignancies undergoing robotic surgery,” Gynecologic Oncology, vol. 128, no. 2, pp. 309–315, 2012.
[41]
R. W. Holloway, L. A. Brudie, J. A. Rakowski, and S. Ahmad, “Robotic-assisted resection of liver and diaphragm recurrent ovarian carcinoma: description of technique,” Gynecologic Oncology, vol. 120, no. 3, pp. 419–422, 2011.
[42]
J. F. Magrina, V. Zanagnolo, B. N. Noble, R. M. Kho, and P. Magtibay, “Robotic approach for ovarian cancer: perioperative and survival results and comparison with laparoscopy and laparotomy,” Gynecologic Oncology, vol. 121, no. 1, pp. 100–105, 2011.
[43]
J. F. Magrina, M. Espada, R. Munoz, B. N. Noble, and R. M. C. Kho, “Robotic adnexectomy compared with laparoscopy for adnexal mass,” Obstetrics and Gynecology, vol. 114, no. 3, pp. 581–584, 2009.
[44]
C. R. Wheeless Jr. and B. H. Thompson, “Laparoscopic sterilization. Review of 3600 cases,” Obstetrics and Gynecology, vol. 42, no. 5, pp. 751–758, 1973.
[45]
M. A. Pelosi and M. A. Pelosi III, “Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture,” New Jersey Medicine, vol. 88, no. 10, pp. 721–726, 1991.
[46]
A. N. Fader and P. F. Escobar, “Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report,” Gynecologic Oncology, vol. 114, no. 2, pp. 157–161, 2009.
[47]
A. N. Fader, L. Rojas-Espaillat, O. Ibeanu, F. C. Grumbine, and P. F. Escobar, “Laparoendoscopic single-site surgery (LESS) in gynecology: a multi-institutional evaluation,” American Journal of Obstetrics and Gynecology, vol. 203, no. 5, pp. 501.e1–501.e6, 2010.
[48]
A. Fagotti, D. M. Boruta II, G. Scambia, F. Fanfani, A. Paglia, and P. F. Escobar, “First 100 early endometrial cancer cases treated with laparoendoscopic single-site surgery: a multicentric retrospective study,” American Journal of Obstetrics and Gynecology, vol. 206, no. 4, pp. 353.e1–353.e6, 2012.
[49]
F. Fanfani, C. Rossitto, M. L. Gagliardi et al., “Total laparoendoscopic single-site surgery (LESS) hysterectomy in low-risk early endometrial cancer: a pilot study,” Surgical Endoscopy and Other Interventional Techniques, vol. 26, no. 1, pp. 41–46, 2012.
[50]
P. F. Escobar, M. Frumovitz, P. T. Soliman et al., “Comparison of single-port laparoscopy, standard laparoscopy, and robotic surgery in patients with endometrial cancer,” Annals of Surgical Oncology, vol. 19, no. 5, pp. 1583–1588, 2012.
[51]
P. F. Escobar, D. C. Starks, A. N. Fader, M. Barber, and L. Rojas-Espalliat, “Single-port risk-reducing salpingo-oophorectomy with and without hysterectomy: surgical outcomes and learning curve analysis,” Gynecologic Oncology, vol. 119, no. 1, pp. 43–47, 2010.
[52]
P. F. Escobar, A. N. Fader, N. Rasool, and L. R. Espalliat, “Single-port laparoscopic pelvic and para-aortic lymph node sampling or lymphadenectomy: development of a technique and instrumentation,” International Journal of Gynecological Cancer, vol. 20, no. 7, pp. 1268–1273, 2010.
[53]
P. F. Escobar, A. N. Fader, M. F. Paraiso, J. H. Kaouk, and T. Falcone, “Robotic-assisted laparoendoscopic single-site surgery in gynecology: initial report and technique,” Journal of Minimally Invasive Gynecology, vol. 16, no. 5, pp. 589–591, 2009.
[54]
P. F. Escobar, G.-P. Haber, J. Kaouk, M. Kroh, S. Chalikonda, and T. Falcone, “Single-port surgery: laboratory experience with the daVinci single-site platform,” Journal of the Society of Laparoendoscopic Surgeons, vol. 15, no. 2, pp. 136–141, 2011.
[55]
P. F. Escobar, M. Kebria, and T. Falcone, “Evaluation of a novel single-port robotic platform in the cadaver model for the performance of various procedures in gynecologic oncology,” Gynecologic Oncology, vol. 120, no. 3, pp. 380–384, 2011.
[56]
J. I. Einarsson, S. L. Cohen, and S. Puntambekar, “Orifice-assisted small-incision surgery: case series in benign and oncologic gynecology,” Journal of Minimally Invasive Gynecology, vol. 19, no. 3, pp. 365–368, 2012.
