Minimally Invasive Gynecologic Surgery For Benign Conditions: Progress And Challenges

OBSTETRICAL & GYNECOLOGICAL SURVEY(2015)

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Abstract
Objective The objective of this review is to evaluate the progress made in laparoscopic and hysteroscopic gynecologic surgery and address challenges still faced by surgeons using minimally invasive techniques to improve the care of women with noncancerous gynecologic problems.Methods Relevant literature was reviewed and evidence-based arguments put forward in the article for the progress that has been made and the deficiencies that still exist.Results In the last 2 decades, enormous progress has been made in providing minimally invasive surgical options for women with gynecologic diseases. The progress has been especially striking in the performance of hysterectomy, the most common major surgery performed on nonpregnant women. The recent controversy over power morcellation has revealed a poor understanding of the literature concerning leiomyosarcoma leading to confusion and consequently denial of minimally invasive surgical options for many women. Hysteroscopic surgery has been evolving rapidly with the development of hysteroscopic morcellator, global endometrial ablation systems, and hysteroscopic tubal sterilization.Conclusions Although huge advances have been made in minimally invasive gynecologic surgery, high-quality evidence from well-designed clinical trials is lacking for many of the new technologies. Accurate estimates regarding the risk of occult leiomyosarcoma are also lacking. Additional research is urgently needed to address these deficiencies.Target Audience Obstetricians and gynecologists, family physicians.Learning Objectives After completing this activity, the learner will be better able to describe the progress made and challenges still facing laparoscopic surgery in women; explain the misconceptions surrounding the controversy over power morcellation of uterine fibroids; and describe the progress made and challenges still facing hysteroscopic surgery in women.
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