OPERATIVE LAPAROSCOPY AND THE GYNECOLOGIC ONCOLOGIST - COMMENTARY ANDREVIEW

Background. 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 b eing performed with the use of laparoscopic surgical techniques. Lapar oendoscopic techniques have limitations as well as advantages over con ventional surgical approaches. Methods. The medical literature as it r elates to laparoscopy and gynecologic oncology was reviewed. Results. Procedures performed through the laparoscope include total hysterectom ies, bilateral oophorectomies, pelvic and periaortic lymphadenectomies , omentectomies, colostomies, bowel resections, oophoropexies, and pel vic lid constructions as well as radical hysterectomies and ovarian ca ncer debulking procedures. These techniques are gaining popularity amo ng gynecologic oncologists, and studies of individual case reports hav e been followed by studies involving a series of patients. Numerous li miting factors exist, however, foremost among these being the wide var iability of endoscopic skills among surgeons and lack of objective lon g term data supporting the efficacy and safety of these techniques. Co nclusion. Application of endoscopic techniques in gynecologic oncology procedures is occurring rapidly and is driven partly by market econom y forces. Many gynecologic oncologists, however, do not have the neces sary endoscopic skills and experience with which to perform such proce dures. For these physicians to remain sufficiently qualified, fellowsh ip training programs must encompass formal training curricula in endos copic surgery, and such programs should often include the faculty as w ell. Formal and organized credentialing of laparoscopic cancer surgica l expertise will ensure a minimum safe level of skills.