Laparoscopic Hysterectomy for Oncologic Patients

It has been well established that minimally invasive surgery (MIS) offers many benefits compared to laparotomy including decreased blood loss and risk of transfusion, a faster less painful recovery, and a shorter (or no) hospital stay. The application of MIS to the field of gynecologic oncology continues to evolve in response to new research and its effect on cancer specific outcomes. Laparoscopy has long been accepted for the staging, and management of early-stage endometrial cancer and MIS is now largely considered standard of care after the emergence of prospective randomized data to support equivalent oncologic outcomes. Conversely, practice has recently trended away from minimally invasive radical hysterectomy for the management of early-stage cervical cancer based on randomized prospective data demonstrating worse outcomes when compared to laparotomy. Current guidelines also recommend laparotomy for primary treatment of advanced ovarian, fallopian tube, and primary peritoneal malignancy. Recent findings suggest there may be a role for minimally invasive techniques for early-stage ovarian cancer and interval debulking after neoadjuvant chemotherapy in select patients. This chapter highlights the most updated research and clinical guidelines regarding the application of MIS for gynecologic malignancies and describes techniques for laparoscopic hysterectomy and related procedures specific to oncologic patients.