Advancing gynecological oncology through endoscopy

In recognition of Gynecological Cancer Awareness Month, GLOWM's newly completed volume on Gynecological Endoscopy highlights significant advancements in surgical approaches that offer new hope and improved outcomes for oncological patients. From minimally invasive techniques to advanced technology and targeted strategies, the field is evolving toward more precise, less morbid interventions.

The rise of minimally invasive surgery and anatomical precision

Laparoscopic and robotic-assisted surgeries are now staples in gynecological oncology. Diagnostic laparoscopy, for instance, is a standard tool in the management of adnexal masses and has an important role in the diagnosis and staging of early ovarian cancers, as well as assessing the extent of advanced disease. In parallel, laparoscopic total hysterectomy, a cost-effective, minimally invasive procedure, has demonstrated clear benefits over traditional open surgery, including reduced pain, less blood loss, shorter hospital stays, and a faster return to daily activities. Similarly, robotic surgery provides surgeons with enhanced dexterity through wristed instruments, 3D visualization, and tremor reduction, making complex procedures like radical hysterectomy for cervical cancer more precise. The mastery of anatomical spaces, such as the paravesical and pararectal spaces, is critical for these procedures to enable nerve-sparing techniques that preserve bladder, rectal and sexual function, significantly improving a patient's quality of life.

Sentinel lymph node mapping: a targeted approach

The surgical management of gynecological cancers is also being refined by the adoption of sentinel lymph node (SLN) mapping. This less invasive alternative to complete lymphadenectomy is now a standard of care for endometrial and cervical cancers, reducing the morbidities associated with lymph node removal, such as lymphedema. By identifying the primary lymph node most likely to contain cancer, this technique helps avoid unnecessary extensive dissection in patients in whom the SLN is negative. This selective approach has shown high sensitivity and a strong negative predictive value, ensuring adequate staging without compromising oncological outcomes.

While traditional therapies like surgery, radiation and chemotherapy remain cornerstones in the treatment of early-stage endometrial and cervical cancers, these modern surgical and staging techniques represent a significant paradigm shift. They underscore a commitment to not only curing the disease but also preserving patient function and wellbeing.

These chapters and 10 more in the whole volume of Gynecological Endoscopy, expertly co-edited by Professor Alberto Mattei and Dr Federica Perelli, are freely accessible here: Gynecological endoscopy | Gynecology Volume Contents | GLOWM