LAPAROSCOPIC SURGERY IN GYNECOLOGIC ONCOLOGY

Laparoscopic pelvic lymphadenectomy was devised at about the same time as was the laparoscopic cholecystectomy. It is estimated that, 2 years after the first published description of laparoscopic cholecystectomy,¹⁸ more than 80% of cholecystectomies were, worldwide, performed with the laparoscope. We are far from this extensive acceptance more than 10 years after the laparoscopic pelvic lymphadenectomy was first described, however.¹³ One explanation for this delay is that gynecologic oncologists are much less numerous than are general surgeons. As a consequence, the pressure for change is less on gynecologic oncologists than it was on general surgeons; however, if the advantages of laparoscopic surgery were as obvious in gynecologic oncology as they are in biliary lithiasis, gynecologic oncologists undoubtedly would have been converted regardless of the length and difficulties of added training required for surgeons who regularly perform open radical pelvic surgery. It must be recognized that the benefits of laparoscopic surgery in its current stage of development are not sufficiently convincing from the viewpoint of patients or surgeons. Moreover, the safety of laparoscopic procedures for cancer treatment is questionable. This article addresses the questions concerning the future of laparoscopy in gynecologic oncology after describing how this surgery developed and its current place in the management of gynecologic malignancies.