The role of Laparoscopic Surgery in Gynecologic Oncology
Until very recently, laparoscopy was believed to have no role in the treatment of gynecologic cancer. The medical establishment once considered open surgery, or laparotomy, to be the only acceptable way to view the extent or stage gynecologic cancer. As with any surgery, careful identification and isolation of the anatomy is critical to the success of the surgery, but with malignancy, the risk of complications from surgery are increased. With surgical treatment for cancer, the number one concern is the spread of disease into the body. For this reason, clear visualization of the affected area is of primary importance.
Traditional laparoscopy has been considered to be of limited use in oncology because it is difficult to get a good view of the pelvic anatomy, including all the connective tissue and lymph nodes that play a critical role in the management of cancer. However, with the advent of Advanced Laparoscopic Surgery, there is a turning point in the surgical treatment of gynecologic cancer. As the medical data builds that oncology surgeries can be performed safely and effectively, the community is beginning to establish recommendations for itself; recommendations that suggest they need guidelines for physicians to become adequately trained in order to adopt these techniques.
There are very few surgeons trained in Advanced Laparoscopic Surgery for gynecologic oncology, but those who perform these procedures publish their findings month after month in the medical literature. In August 2009 the Journal of the Society of Gynecologic Oncologists summarized the state of the gynecologic oncology community with regard to minimally invasive surgery. There is no argument of the benefits of minimally invasive surgery for patients with gynecologic malignancy. These benefits are even more pronounced for patients battling cancer than with benign conditions. Patients who receive minimally invasive surgery have much shorter surgical times, far fewer complications, faster and less painful recovery, and feel better faster. This means that patients who have to have adjuvent chemotherapy or radiation can start treatment sooner. And for everyone fighting cancer, feeling good has an enormous impact on your outlook and recovery.
There is, however, an enormous lack of medical training to perform these surgeries safely and effectively. While there is no standard training program for minimally invasive surgery for gynecologic oncology, one suggestion that has been made is that after doctors complete standard training (through their OB/GYN residency program), they should go on to perform at least 100 laparoscopic hysterectomies in order to refine their surgical skill and continue to perform a high number of advanced laparoscopic cases in order to maintain their surgical skills. The Women's Surgery Center performs more major laparoscopic surgery than any other practice in the region and is one of the only medical practices in the U.S. that approaches almost all of our oncology cases laparoscopically.
Please refer to our Patient Guide for advice on how to determine whether your doctor is the most qualified to treat your condition. And for more information about how the Women's Surgery Center approaches treatment for gynecologic cancers, please review the section on your particular condition.