6 - Role of laparoscopic surgery

Summary

Introduction

The first decade of the 21st century has seen minimal access surgery in oncology progress from simple laparoscopically assisted vaginal procedures to complex operations such as radical hysterectomy and lymph node dissection. Laparoscopic surgery is associated with reduced levels of postoperative pain, early discharge from hospital and an earlier return to normal activity. However, many surgeons have been reluctant to replace abdominal radical surgery with laparoscopic surgery because of concerns that it does not replicate the radicalism of open surgery. In 1987, Dargent reported combining a radical vaginal hysterectomy with a laparoscopic pelvic lymph node dissection in the management of cervical cancer. Following this, a number of reports have been published on the feasibility and safety of laparoscopic surgery in treating gynaecological cancer. More recently, new energy modalities, such as the argon beam coagulator and the harmonic scalpel, have allowed safe dissection of tissue with minimal thermal spread to nearby structures.

Cervical cancer

The management of cervical cancer is based on the extent of disease spread using the FIGO staging system. This is based on clinical examination and limited radiological assessment. Clinical staging allows only limited assessment of the nodal status, which is considered one of the most important prognostic factors.