title: [Endoscopic management of gynecological malignancies: an update. 2007].
abstract: All the different surgical procedures used to treat gynecologic cancers have already been performed with the endoscopic approach. However, the prospective randomized trials required to confirm the oncologic efficacy of this approach are still lacking in gynecology, whereas such studies are available for abdominal surgery. Animal studies suggest that the risk of tumor dissemination in the non traumatized peritoneum may be higher after pneumoperitoneum than after laparotomy, and they also show the importance of the surgeon's experience and technique. All the parameters of pneumoperitoneum can influence the risk of postoperative dissemination. By controlling these parameters we may, in future, be able to create a peritoneal environment suitable for oncologic indications and thereby prevent or minimize the risk of peritoneal dissemination and postoperative tumor growth. In endometrial cancer, the laparoscopic approach should be reserved for clinical stage I disease, if the volume of the uterus and local conditions are appropriate for vaginal extraction. In cervical cancer, the laparoscopic approach should be reserved for patients with favorable prognostic factors (stage IB, less than 2 cm in diameter). Laparoscopy is the gold standard for surgical diagnosis of adnexal masses, but puncture should be avoided whenever possible. Surgical treatment of invasive ovarian cancer should use laparotomy, whatever the stage. In contrast, restaging of early ovarian cancer initially managed as a benign mass is a good indication for the laparoscopic approach. Laparoscopic management of tumors with low malignant potential should include complete staging of the peritoneum. An excellent knowledge of the principles of endoscopy and of oncologic surgery is required. Training in endoscopic oncological techniques will be a major challenge in the field of gynecologic surgery in coming years.
authors.affiliation: Gynécologie obstétrique et médecine de la reproduction, Université d'Auvergne Clermont 1, Polyclinique de l'Hôtel Dieu, CHU de Clermont-Ferrand. mcanis@chu-clermontferrand.fr
authors.forename: Michel
authors.initials: M
authors.lastname: Canis
authors.forename: Kris
authors.initials: K
authors.lastname: Jardon
authors.forename: Julien
authors.initials: J
authors.lastname: Niro
authors.forename: Benoit
authors.initials: B
authors.lastname: Rabischong
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bourdel
authors.forename: Revaz
authors.initials: R
authors.lastname: Botchorishvili
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pouly
authors.forename: Gerard
authors.initials: G
authors.lastname: Mage
mesh_terms: D000818:Animals; D002277:Carcinoma / Q000556:secondary / Q000601:surgery; D016889:Endometrial Neoplasms / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D009366:Neoplasm Seeding; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000556:secondary; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods; D013552:Swine; D002583:Uterine Cervical Neoplasms / Q000601:surgery