Minimally Invasive Gynecologic Surgery

Dear Colleagues,

Minimally invasive gynecologic surgery is the use of techniques, such as laparoscopy or hysteroscopy, to surgically treat gynecologic diseases. Minimally invasive procedures require no or several small incisions rather than one large incision. In the last two decades, minimally invasive surgery (MIS) has become common in gynecologic practice. Many investigators have assessed the feasibility, adequacy, and safety of hysteroscopy, laparoscopy or the robotic approach in gynecological surgery. MIS has become the standard approach to various benign and malignant gynecologic diseases by shortening the days of hospitalization, improving surgical outcomes, and quickening the return to daily activities. Moreover, technological innovation is constantly redefining the concept of the ‘minimal’ surgical approach. Progressively reducing surgical invasiveness can result in smaller or fewer incisions with subsequent decrease in pain, lower risk of infection, and shorter hospital stay. This strategy is increasingly being utilized in benign conditions.

Previous studies that have investigated MIS in different gynecologic tumors have yielded contradictory results. For example, MIS improves perioperative outcomes among women with early-stage endometrial cancer without impairing survival. In contrast, in early-stage cervical cancer, MIS radical hysterectomy is inferior to open radical hysterectomy. However, an international multicenter randomized trial (RCT) investigating the robotic approach (RACC trial) is ongoing in this group of patients. Despite the absence of high-quality evidence, the use of MIS for ovarian cancer, especially for interval cytoreductive surgery, is on the rise, and an international RCT (LANCE trial) is ongoing in the neoadjuvant setting of advanced ovarian cancer patients.

Our purpose in this special issue is to report the current knowledge on the minimally invasive management of benign and malignant gynecologic diseases. In the current era of precision medicine and personalized treatment, we aim to highlight the need for a more tailored patient selection.

Assoc. Prof. Dr. Stefano Cianci and Assoc. Prof. Dr. Carmine Conte

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