Introduction

Gynaecological oncology surgery encompasses a wide range of procedures including open ultra-radical debulking surgery, advanced laparoscopic procedures and reconstructive vulval and groin surgery. There are common underlying principles that are relevant to all surgical procedures within and outside of gynaecology, alongside principles that are more specific to gynaecological cancer operations. This chapter provides a review of surgical principles in the context of gynaecological cancer surgery. Other perioperative principles will be reviewed, including surgical complications, peri- and postoperative care, enhanced recovery (ER) and special issues relating to challenging patients.

Basics of Surgical Principles

Box 8.1 provides a comprehensive summary of basic principles that should be considered when undertaking surgery.

Preoperative, Intraoperative and Postoperative Issues

Preoperative

Preoperative assessment and optimisation are essential in gynaecological oncology patients as they are, in general, likely to be older with more complex comorbidities than the general gynaecological surgical patient. Thorough history-taking is essential to identify significant comorbidities which may have an impact on surgical planning, postoperative care and identification of potential intra- and postoperative complications.

Several preoperative investigations may be necessary to identify risks and to identify those whose clinical condition needs to be optimised prior to surgery Preoperative investigations may include

A detailed discussion of the individual patient's needs and expectations preoperatively will help determine an individualised patient approach. For example, a discussion on the impact of treatment on fertility and the availability of fertility-sparing options is vital in young women. The contribution of the Clinical Nurse Specialist from the start of the process cannot be understated.