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  • Print publication year: 2008
  • Online publication date: December 2009

16 - GYNECOLOGIC MALIGNANCY

Summary

Laparoscopy has been used for second-look assessments in ovarian cancer since first described in 1973 by Bagley et al. However, it was new developments in equipment and instrumentation, such as videolaparoscopy, high pressure insufflators, and energy sources, in the late 1980s to early 1990s — combined with the work of some of the pioneers of laparoscopic surgery — that made the use of operative laparoscopy in gynecologic oncology feasible. Dargent and Salvat, Querleu et al., and Nezhat et al. first established the safety and practicability of laparoscopic retroperitoneal and intraperitoneal lymphadenectomy and radical hysterectomy. An increasing number of surgeons have since used advanced operative techniques for evaluation and surgical management of gynecologic cancers.

Laparoscopy has the benefit of image magnification to aid in identification of metastatic or recurrent disease, especially in areas such as the upper abdomen, liver and diaphragm surfaces, posterior cul-de-sac, bowel, and mesenteric surfaces. In addition, challenging retroperitoneal spaces of the pelvis, such as the paravesical, pararectal, vesicovaginal, and especially the rectovaginal space, can be accessed laparoscopically. Additional benefits of laparoscopy in gynecologic oncology surgery include limited bleeding from small vessels due to the pressure established by pneumoperitoneum, elimination of large abdominal incisions, shortened hospital stay, and rapid recovery.