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Recent Advances in Minimally Invasive Surgery and Endoscopy of Gynecologic Oncology

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A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 25 November 2026 | Viewed by 2250

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Editors

Dr. Hiroaki Komatsu

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Guest Editor

Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago 683-5804, Tottori, Japan
Interests: ovarian cancer; gynecologic cancer; robotic surgery

Dr. Eiji Kondo

E-Mail Website
Guest Editor

Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu 514-8507, Japan
Interests: cervical cancer; ovarian cancer; endometrial cancer; minimally invasive surgery; clinical trial
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Prof. Dr. Tsukasa Baba

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Guest Editor

Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2‑1‑1, Idaidori, Yahaba, Iwate 028-3695, Japan
Interests: ovarian cancer; cancer therapy; tumors; cancer cell line; cancer; metastasis; cancer cells; hysterectomy; gynecology; obstetrics

Special Issue Information

Dear Colleagues,

In recent years, robotic surgery has rapidly expanded worldwide in gynecologic practice. Notably, with the emergence of several new robotic surgical platforms, the era of a single dominant system is coming to an end.

For this Special Issue, we would like to place a strong focus on robotic platforms other than the da Vinci system and highlight their clinical effectiveness, innovation, and unique technological characteristics. We aim to collect high-quality contributions that explore not only surgical outcomes and feasibility but also platform-specific advantages, novel applications, and future directions in minimally invasive gynecologic surgery.

In addition, we welcome submissions that introduce and compare the distinctive features of robotic platform development across different countries and regions. For example, in Japan, platforms such as hinotori and Hugo have been increasingly adopted and are beginning to shape new clinical opportunities.

We hope that these next-generation robotic systems will serve as new foundations for gynecologic surgery and stimulate further advancement in surgical techniques and innovation in the field. We sincerely invite researchers and clinicians to contribute original studies and reviews.

Dr. Hiroaki Komatsu
Dr. Eiji Kondo
Prof. Dr. Tsukasa Baba
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cervical cancer
ovarian cancer
gynecologic cancer
robotic surgery
minimally invasive surgery

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Research

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17 pages, 303 KB

Open AccessArticle

Robotic Versus Open Radical Hysterectomy in Early-Stage Cervical Cancer: A Comparative Cohort Study

by Anna Jędrzejczyk, Krzysztof Mawlichanów, Agnieszka Golec-Cera and Marcin Opławski

J. Clin. Med. 2026, 15(13), 5168; https://doi.org/10.3390/jcm15135168 - 2 Jul 2026

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Abstract

Background/Objectives: Following the LACC trial, the role of minimally invasive radical surgery for early-stage cervical cancer remains controversial. Robotic-assisted approaches have been proposed as a potential strategy to preserve the benefits of minimally invasive surgery while incorporating contemporary oncologic precautions. This study compared perioperative, pathological, and early oncologic outcomes between robotic and open radical surgical management in patients with FIGO 2018 stage IA2–IIA1 cervical cancer. Methods: Patients underwent robotic surgery (n = 20; da Vinci Xi), including robotic radical hysterectomy, compartment-based procedures, and fertility-sparing surgery when clinically indicated, or open abdominal radical hysterectomy (n = 22). Perioperative outcomes, histopathological parameters (including lymphovascular space invasion [LVSI], lymph node status, and margin status), and early oncologic outcomes were evaluated. Exploratory multivariable regression analyses were performed to adjust for baseline differences, including age and tumor size. Results: Patients in the open-surgery cohort were older (56.23 ± 15.87 vs. 45.67 ± 9.31 years; p = 0.012) and had significantly larger tumors (3.07 ± 1.10 vs. 1.4 ± 0.7 cm; p = 0.003). Robotic surgery was associated with longer operative time (178 ± 42 vs. 150 ± 38 min; p = 0.028), lower blood loss (112 ± 61 vs. 518 ± 98 mL; p < 0.001), and shorter hospital stay (4.2 ± 1.6 vs. 6.2 ± 1.4 days; p < 0.001). The robotic cohort also demonstrated a higher lymph node yield (median 18 vs. 9; p < 0.001). No statistically significant differences were observed between groups in lymph node metastasis (20.0% vs. 22.7%; p = 1.000), LVSI (33.3% vs. 63.6%; p = 0.121), or R0 resection rate (100% vs. 95.5%; p = 1.000). In exploratory adjusted analyses, surgical approach was not associated with adverse pathological features, whereas tumor size emerged as an independent predictor of both lymph node metastasis and LVSI. No recurrences were observed in the robotic cohort during the available follow-up period. Conclusions: In this exploratory comparative cohort study, robotic radical surgical management in carefully selected patients with predominantly small-volume disease was associated with favorable perioperative outcomes and no statistically significant differences in pathological parameters compared with open surgery. Tumor size, rather than surgical approach, emerged as the principal predictor of adverse pathological features. Given the limited sample size, baseline imbalances between cohorts, heterogeneous robotic procedures, and absence of mature survival data, these findings should not be interpreted as evidence of oncologic equivalence and require confirmation in larger prospective studies. Full article

(This article belongs to the Special Issue Recent Advances in Minimally Invasive Surgery and Endoscopy of Gynecologic Oncology)

13 pages, 6846 KB

Open AccessArticle

Initial Experience with Dual-Tracer Sentinel Lymph Node Mapping Using RI and ICG in Robot-Assisted Surgery for Early-Stage Endometrial Cancer: A Prospective Exploratory Study

by Masayo Okawa, Hiroaki Komatsu, Yuki Hiratsuka, Koji Yamamoto, Kohei Hikino, Yuki Iida, Mayumi Sawada, Shinya Sato and Fuminori Taniguchi

J. Clin. Med. 2026, 15(12), 4705; https://doi.org/10.3390/jcm15124705 - 17 Jun 2026

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Abstract

Background/Objectives: Sentinel lymph node (SLN) biopsy is a minimally invasive alternative to systematic lymphadenectomy for endometrial cancer staging. However, optimization of SLN identification during robot-assisted surgery remains an important clinical issue. This prospective exploratory study evaluated the feasibility and mapping characteristics of dual-tracer SLN mapping combining radioisotope (RI) and indocyanine green (ICG) in robot-assisted surgery for clinical stage IA endometrial cancer. Methods: Ten patients with clinical stage IA endometrioid carcinoma (grade 1 or 2) who underwent robot-assisted surgery at our institution between June 2025 and March 2026 were prospectively enrolled. Technetium-99m phytate was injected cervically the day before surgery, followed by SPECT-CT imaging. ICG was administered intraoperatively. SLNs were identified using both RI mapping and near-infrared fluorescence imaging. All patients subsequently underwent pelvic lymphadenectomy. SLN detection rates, concordance between tracers, intraoperative findings, and perioperative outcomes were evaluated. Results: The SLN detection rate with the dual-tracer method was 100% (10/10). RI mapping alone achieved bilateral detection in 30% (3/10), whereas ICG fluorescence imaging identified SLNs in all patients (100%). All RI-positive SLNs were also identified by ICG fluorescence imaging. In several cases, multiple fluorescent lymph nodes were observed, and gamma-probe assessment aided intraoperative SLN selection. No lymph node metastases were identified. One Clavien–Dindo grade IIIa complication (pelvic hematoma requiring intervention) occurred. No adverse events related to ICG were observed. Conclusions: Dual-tracer SLN mapping using RI and ICG was feasible in robot-assisted surgery for clinical stage IA endometrial cancer. ICG fluorescence imaging provided sensitive lymphatic visualization, whereas RI mapping offered complementary information for intraoperative SLN identification in selected cases. Further prospective studies with larger cohorts are required to clarify the clinical utility of the dual-tracer approach. Full article

(This article belongs to the Special Issue Recent Advances in Minimally Invasive Surgery and Endoscopy of Gynecologic Oncology)

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34 pages, 641 KB

Open AccessSystematic Review

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Patients with Gynecological Malignancies: A Systematic Review

by Aristotelis-Marios Koulakmanidis, Evangelia Kontogeorgi, Dimitrios Zacharakis, Anastasia Prodromidou, Ioakeim Sapantzoglou, Giuseppe Mascellino, Konstantinos Kypriotis, Nikolaos Kathopoulis, Dimos Sioutis, Charalampos Voros, Christos Vrysis, Stavros Athanasiou and Themos Grigoriadis

J. Clin. Med. 2026, 15(11), 4089; https://doi.org/10.3390/jcm15114089 - 25 May 2026

Viewed by 637

Abstract

Aim: The purpose of this study was to investigate the safety, efficacy, and clinical outcomes of the vaginal natural orifice transluminal endoscopic surgery (vNOTES) technique in patients suffering from gynecological cancer. Methods: A systematic review of the literature was conducted from inception to October 2025 following the PRISMA guidelines. PubMed, Google Scholar, and the Cochrane Library were searched for studies investigating vNOTES in gynecological malignancies. Study quality was evaluated using the Newcastle–Ottawa Scale, the National Institute of Health and the Joanna Briggs Institute critical appraisal tools. Results: The search identified 11 observational cohort studies, 28 case series, and 22 case reports. A total of 926 patients with suspected or confirmed gynecologic malignancies underwent surgery via vNOTES approach. The combination of hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node biopsy represented the most commonly performed surgical procedure. Endometrial cancer was the most frequent oncological indication. The included studies evaluated the perioperative outcomes, including operative time, estimated blood loss, lymph node assessment, conversion rates and complications. Conclusions: The vNOTES approach appeared to be feasible and at least non-inferior to standard surgical treatments for patients with early-stage gynecologic malignancies. However, the small sample sizes and heterogeneity among studies limit the strength of the evidence and preclude definitive conclusions. Full article

(This article belongs to the Special Issue Recent Advances in Minimally Invasive Surgery and Endoscopy of Gynecologic Oncology)

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