Operative laparoscopy and the gynecologic oncologist. Commentary and review

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Abstract
A rapid evolution in technology and surgical applications of endoscopy have occurred over the past 5 years. Surgical procedures once thought impossible except through large abdominal incisions are being performed with the use of laparoscopic surgical techniques. Laparoendoscopic techniques have limitations as well as advantages over conventional surgical approaches. The medical literature as it relates to laparoscopy and gynecologic oncology was reviewed. Procedures performed through the laparoscope include total hysterectomies, bilateral oophorectomies, pelvic and periaortic lymphadenectomies, omentectomies, colostomies, bowel resections, oophoropexies, and pelvic lid constructions as well as radical hysterectomies and ovarian cancer debulking procedures. These techniques are gaining popularity among gynecologic oncologists, and studies of individual case reports have been followed by studies involving a series of patients. Numerous limiting factors exist, however, foremost among these being the wide variability of endoscopic skills among surgeons and lack of objective long term data supporting the efficacy and safety of these techniques. Application of endoscopic techniques in gynecologic oncology procedures is occurring rapidly and is driven partly by market economy forces. Many gynecologic oncologists, however, do not have the necessary endoscopic skills and experience with which to perform such procedures. For these physicians to remain sufficiently qualified, fellowship training programs must encompass formal training curricula in endoscopic surgery, and such programs should often include the faculty as well. Formal and organized credentialing of laparoscopic cancer surgical expertise will ensure a minimum safe level of skills.