Search Results (116)

Background/Objectives: Peritoneal metastasis represents the most frequent and prognostically unfavorable metastatic pattern in gastric cancer, largely due to limited sensitivity of conventional imaging, delayed diagnosis, and insufficient response assessment. The aim of this review is to provide an overview of the current evidence on the diagnosis and treatment of gastric cancer with peritoneal metastases and to address current treatment limitations and options. Methods: This review was designed as a narrative review and is based on an extensive literature search in established databases. Results: Systemic chemotherapy remains the cornerstone of palliative treatment, improving the survival and quality of life compared with the best supportive care; however, outcomes in peritoneally metastatic disease remain poor. Advances in molecularly targeted and immune-based therapies have extended survival in selected patient populations, yet favorable molecular profiles are mainly unknown in peritoneal metastases. Staging laparoscopy and semi-quantitative assessment using the Peritoneal Cancer Index (PCI) are therefore essential for accurate diagnosis, prognostication, and treatment selection. Growing evidence from retrospective studies, multi-institutional cohorts, and selected randomized trials suggests that a multimodal approach—combining systemic therapy with intraperitoneal or bidirectional chemotherapy—may improve survival and quality of life. In carefully selected patients whose primary gastric tumor and peritoneal lesions respond to systemic treatment, complete cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) may further enhance outcomes and, in rare cases, achieve long-term survival. These potential benefits appear to be limited to highly selected patients with a low peritoneal tumor burden (PCI ≤ 6–7), positive cytology, good performance status, controlled extraperitoneal disease, and a high likelihood of achieving complete macroscopic cytoreduction (CC-0). Conclusions: Although the treatment intent in metastatic gastric cancer remains primarily palliative, carefully selected patients with limited peritoneal metastases may benefit from intensified multimodal treatment strategies when managed in specialized centers. Interdisciplinary evaluation, accurate staging, and individualized treatment planning are essential to optimize outcomes in this challenging disease setting. Full article

Background/Objectives: Neoadjuvant therapy (NAT) is now central to the management of borderline resectable (BRPC) and locally advanced (LAPC) pancreatic ductal adenocarcinoma (PDAC). This narrative review summarizes contemporary evidence and guidelines from a surgical perspective, with emphasis on pretreatment classification, post-NAT selection for exploration, intraoperative vascular strategy, and postoperative management. Methods: We conducted a structured narrative review of randomized and prospective studies, high-quality observational cohorts, and major international guidelines published through 31 July 2025. Results: BRPC and LAPC remain primarily defined by vascular anatomy, but biologic and conditional factors are increasingly integrated into decision-making. NAT is the preferred initial strategy for BRPC and the standard induction approach for LAPC, with resection considered only in carefully selected responders. After NAT, contrast-enhanced CT combined with CA19-9 kinetics remains the core restaging platform, while FDG-PET, diffusion-weighted MRI, radiomics, and circulating biomarkers may serve as adjuncts in equivocal cases. Surgical exploration should be guided by physiologic recovery, the absence of metastatic progression, and multidisciplinary reassessment. Staging laparoscopy remains useful for detecting occult metastatic disease. Intraoperatively, vascular resection should be margin-driven rather than routine, with portal–mesenteric venous resection established in expert centers, whereas arterial resection remains highly selective. Periarterial divestment represents an artery-sparing alternative in selected cases. NAT does not appear to worsen short-term postoperative outcomes, but anticoagulation after venous reconstruction remains non-standardized. Conclusions: NAT has transformed BRPC/LAPC PDAC into a biology-gated, time-sequenced surgical pathway. Standardized reassessment, careful candidate selection, and the centralization of complex vascular procedures are essential to optimize outcomes. Full article

Introduction: Understanding superficial epigastric vessel anatomy is crucial for abdominal surgeries like laparoscopy, especially in neonates, to prevent injury. While standard courses are described, variations occur. This case report highlights a unique anatomical variation in the superficial epigastric artery found during the dissection of a stillborn neonatal cadaver. Case Report: In contrast to the usual origin from the femoral artery, this variation features the inferior epigastric artery penetrating the anterior abdominal wall near the umbilicus and branching superiorly to supply the superficial abdominal wall. Conclusions: This distinctive vascular configuration, which to the best of our knowledge has not been previously described in neonatal anatomical literature, diverges from the typical symmetrical arrangement and previously reported variations. The study stresses the clinical importance of this finding, especially for laparoscopic procedures in neonates. During trocar placement, surgeons should be cognizant of such variations to reduce the risk of iatrogenic injuries, including rectus sheath hematoma. The report highlights the need for further investigation to establish the prevalence of this variation and its potential effects on surgical safety and outcomes in a broader neonatal population, which may also reflect the dynamic vascular remodeling that occurs during early developmental stages. Full article

Background: Minimally invasive hysterectomy with sentinel lymph node (SLN) mapping is standard for early-stage endometrial cancer, but comparative real-world data on robot-assisted (RAH) versus conventional laparoscopy (TLH) remain limited. This study aimed to compare the two techniques in a real-world clinical setting. Methods: We retrospectively reviewed medical records of 140 patients with FIGO stage I endometrial cancer who underwent RAH or TLH at Semmelweis University between January 2022 and December 2024. We analyzed patient demographics, sentinel lymph node (SLN) detection rates, conversion rates, operative time, pathological characteristics. Results: Baseline demographic and oncologic characteristics were comparable. SLN detection was significantly higher in the RAH group compared to TLH (98% vs. 90.2%, p = 0.04). Conversion to laparotomy occurred in 0% of RAH cases versus 11.5% of TLH cases (p = 0.0024). Conclusions: In a standardized ICG-guided SLN mapping setting, RAH achieved higher SLN detection and markedly lower conversion rates than TLH, without differences in operative time or key pathological parameters. Full article

Background: Pancreatic cancer (PC) has a very poor 5-year survival and prognosis. Even when CT or MRI shows no metastasis, staging laparoscopy(SL) still detects tiny peritoneal deposits in 20–30% of patients, making them ineligible for surgery. SL is invasive, requiring general anesthesia and substantial resources. Endoscopic ultrasound (EUS) allows the observation of the bile ducts, pancreas, and abdominal cavity, and EUS-guided fine-needle aspiration (EUS-FNA) is essential for pathological diagnosis. Reports on using EUS to perform peritoneal lavage cytology are currently not available. We hypothesized that combining EUS-FNA with peritoneal lavage (EUS-lavage technique; EUS-LT) could enhance staging accuracy and avoid unnecessary surgical procedures. Methods: Ten in vivo porcine models underwent EUS-LT. Using a 19G FNA needle, 800 mL saline was instilled into the intraperitoneal cavity and then recovered. Two refinements were introduced sequentially: an ENBD catheter with additional side holes and, subsequently, a side-hole introducer (EndoSheather) that eliminated balloon dilation. The primary endpoint was procedural success. Secondary endpoints included safety, complications, recovered volume, duration of endoscopic procedure, and time required to instill 800 mL. Nonparametric tests compared outcomes across iterations. Results: Ten-model porcine in vivo model series were included, and all procedures were successful. No device malfunctions or unanticipated technical failures; one minor mucosal injury during saline injection resolved after re-puncture. The average procedure time was 31.1 min. Stepwise refinements shortened procedure and infusion times and increased recovered volume. Recovered volume approached the instilled amount in later cases, indicating efficient performance. Conclusions: In this ten-model in vivo series, EUS-LT demonstrated technical feasibility and short-term safety. Full article

Background/Objectives: Endometriosis is a chronic, inflammatory, estrogen-dependent disease that has historically been underdiagnosed, especially in patients with unexplained infertility. On average, diagnosis is delayed by 11 years, underscoring the need for precision medicine to improve outcomes. To compare disease severity and anatomical distribution of endometriosis between patients with unexplained infertility who underwent noninvasive Receptiva BCL6 testing before surgery and those who did not. Methods: A cross-sectional analysis was conducted on 195 women with unexplained infertility and histologically confirmed endometriosis following diagnostic video laparoscopy, with or without robotic assistance. Disease severity was staged using updated guidelines. Anatomical sites of endometriosis were documented. Patients were grouped based on whether they had undergone the Receptiva BCL6 overexpression test prior to surgery. Results: Of the 195 patients, 43 underwent Receptiva testing; 41 of them tested positive and were confirmed to have endometriosis during surgery. These patients had fewer affected anatomical regions (3.14 ± 2.09) compared to those without testing (3.93 ± 2.26; p = 0.04). The No Receptiva group also had more high-stage cases (70.39% vs. 65.12%, p-value: 0.038). In both groups, endometriosis most frequently involved the periureteral region, rectovaginal septum, and ovaries, though ovarian tissue was rarely excised to preserve fertility. Conclusions: Among patients with unexplained infertility and confirmed endometriosis, those who had preoperative Receptiva testing showed lower disease burden and severity. These findings support the potential utility of noninvasive testing to enrich diagnostic accuracy and guide earlier, more targeted intervention. Full article

Background/Objectives: Endometriosis is a chronic inflammatory disease affecting up to 10–15% of women of reproductive age and is frequently associated with pelvic pain and infertility. Non-invasive biomarkers remain insufficient for accurate diagnosis, often necessitating laparoscopic confirmation. The fibrinogen-to-albumin ratio (FAR), a composite marker of systemic inflammation, has been proposed in both oncological and cardiovascular disease but has not yet been evaluated in endometriosis. Methods: We conducted a retrospective monocentric study including 390 women who underwent laparoscopy between January 2015 and December 2021 at the Medical University of Vienna. Of these, 218 had histologically confirmed endometriosis and 172 had benign ovarian cysts. Preoperative laboratory data was collected, and FAR was calculated. Group comparisons were performed using the Mann–Whitney U test. ANOVA was used to compare FAR across revised American Society for Reproductive Medicine (rASRM) stages, and Spearman’s rank correlation assessed associations with disease severity. Subgroup analyses were performed for adenomyosis and deep infiltrating endometriosis (DIE). Results: FAR was significantly higher in women with endometriosis than in controls (median 0.0679, IQR 0.0588–0.0778 vs. 0.0641, IQR 0.0559–0.716; p = 0.0035). Across rASRM stages I–IV, FAR values were comparable (means 0.0691–0.0709) and did not differ significantly (p = 0.822, ANOVA). Spearman’s correlation confirmed no significant association with disease stage (ρ = 0.085, p = 0.24). In exploratory analyses, women with adenomyosis (n = 35) showed a non-significant trend toward a higher median FAR compared to those without adenomyosis (0.0707 vs. 0.0669; p = 0.073, one-sided). No difference in FAR was observed between women with deep infiltrating endometriosis (DIE; n = 144) and those without (0.0680 vs. 0.0672; p = 0.389, one-sided). Conclusions: Although FAR alone cannot replace surgical confirmation, the difference observed between the groups may reflect the systemic inflammatory aspect of endometriosis and should be investigated further in future studies. Given its accessibility and cost-effectiveness, FAR may support the development of non-invasive, personalized diagnostic approaches when combined with other clinical and molecular markers. Full article

Background: Malnutrition is associated with poorer clinical outcomes in esophagogastric cancers (EGCs). Enteral nutrition via feeding jejunostomy (FJ) is feasible and effective, although standardized criteria for its placement during staging laparoscopy (SL) are lacking. Here, we describe a case series with the aim of generate preliminary evidence in highlighting unmet needs in this setting. Methods: We retrospectively reviewed medical records of EGC patients who underwent FJ placement during SL at the Fondazione IRCCS Policlinico S. Matteo from January 2022 to December 2023. Patients with missing nutritional data or known metastatic disease were excluded. Results: We included 14 Caucasian patients aged 66 years (IQR: 56.3–69.5) with a median Body Mass Index (BMI) of 23.7 kg/m² (IQR: 21.6–26.3). The tumor location was the gastroesophageal junction in eight cases (57%), the body of the stomach in four cases (29%), and the esophagus in two cases (14%). At the time of diagnosis, all patients had experienced weight loss: 13.4% of body weight (IQR: 8.7–16.8) in the last 6 months; with high malnutrition risk scores: NRS-2002 = 3 (IQR: 2–4) and MUST = 2 (IQR: 1–2). Prior to FJ placement only four (29%) patients had tried oral nutrition supplements (ONS) and nine (64%) had been evaluated by dietitians. Home enteral nutrition (HEN) was started in twelve (86%) cases, with three (21%) providing total enteral nutrition and 9 (64%) as supplemental HEN, providing a median of 45.5% of energy needs (IQR: 32.6–68.2). Due to sufficient oral intake, HEN was not started in two cases (14%) and was discontinued in the first month in another two cases. In this series, FJ was in place but unused for a median duration of 11 days (IQR: 3–91). The median duration of HEN was 97 days (IQR: 40–135); with 5 (35%) patients achieving weight stability/gain. FJ-related complications requiring hospitalization occurred in three (21%) cases. Conclusions: In this case series, we observed a suboptimal utilization of the FJ. Several patients had not undergone ONS trials or dietitian assessment prior to FJ placement, while others retained the FJ for months without using it. Given the potential risks of FJ, standardized selection criteria are warranted; routine preoperative nutritional assessments before SL should be implemented to identify high-risk patients and optimize FJ placement. Full article

Peritoneal metastases represent one of the most dreadful manifestations of gastric cancer and continue to drive poor outcomes despite significant advances in systemic therapy. Accurate staging—beginning with laparoscopy—remains essential for avoiding non-beneficial surgery and ensuring appropriate allocation to systemic or locoregional treatment pathways. Although modern systemic agents, including immunotherapy and targeted therapies, have transformed the broader management of metastatic disease, their impact in the peritoneal compartment remains limited, reflecting its unique biological and pharmacokinetic constraints. Locoregional approaches such as CRS–HIPEC, PIPAC, and NIPS have expanded the therapeutic armamentarium and have shown encouraging signals in selected populations. Recent randomized studies, including ESTOK01 and PERISCOPE II, emphasize the importance of careful patient selection, technical standardization, and optimal sequencing, while ongoing trials—such as PREVENT, GASTRICHIP, and CONVERGENCE—seek to refine the integration of systemic and intraperitoneal strategies. Yet the field continues to advance without the benefit of validated predictive biomarkers capable of guiding therapeutic decisions. This limitation constrains clinical progress and underscores the need for a stronger translational framework. Future improvement in the management of gastric cancer with peritoneal metastases will depend on the identification of robust biological predictors of response, enabling more rational patient selection and the development of truly personalized multimodal approaches. Full article

Background and Objectives: Sentinel lymph node (SLN) mapping is an established alternative to systematic lymphadenectomy for early-stage endometrial cancer (EC). While retroperitoneal vNOTES affords direct access to pelvic nodes without abdominal incisions, data regarding its oncologic validity remain sparse. This study evaluates the SLN detection rates, perioperative outcomes, and 12-month oncologic outcomes oncologic results of retroperitoneal vNOTES mapping in presumed early-stage EC. Materials and Methods: This single-center retrospective cohort study analyzed consecutive patients undergoing retroperitoneal vNOTES staging (hysterectomy, BSO, and SLN mapping) for presumed EC between February 2023 and January 2024. Eligible patients had radiologically uterine-confined disease and were candidates for transvaginal surgery. Following cervical methylene blue injection, SLN mapping was executed via the retroperitoneal vNOTES route. Mapped and suspicious nodes were excised, with side-specific lymphadenectomy performed for failed mapping per algorithm. While perioperative outcomes were assessed for the full cohort, oncologic analyses (FIGO 2023 staging, nodal metastasis) were restricted to patients with confirmed carcinoma. Results: Of 98 patients (median age 54; BMI 31 kg/m²), final pathology confirmed carcinoma in 78 (73 endometrioid, 5 serous) and EIN in 20. Bilateral SLN mapping succeeded in 87.8% (86/98), necessitating side-specific lymphadenectomy in the remaining 12.2%. The obturator fossa was the predominant nodal basin (43.9%). Within the carcinoma cohort (n = 78), 57.7% were Grade 1 and 74.4% FIGO Stage I. Nodal metastases (FIGO IIIC1) were identified in 12.8% (10/78), all prompting adjuvant therapy. At a median follow-up of 12 months, no disease recurrences were observed. The complication rate was 6.1% (5.1% Clavien–Dindo ≥ III), with no conversions required. At 12-month follow-up, no recurrences were detected, though the absence of systematic lymphadenectomy precluded formal sensitivity analysis. Conclusions: Retroperitoneal vNOTES represents a feasible and safe strategy for SLN mapping in early-stage EC, demonstrating high bilateral detection with minimal morbidity. However, reliance on methylene blue and limited follow-up necessitate caution. Broader implementation requires validation through prospective, comparative trials utilizing indocyanine green and long-term oncologic surveillance. Full article

Background and Aims: Gastric cancer (GC) remains a leading cause of cancer-related mortality, frequently diagnosed at advanced stages. High-risk features—tumor size ≥ 40 mm, cT3/cT4, nodal involvement, diffuse histology, and Borrmann type III/IV—are associated with peritoneal metastasis (PM). Staging laparoscopy with peritoneal washing (PW) is superior to conventional preoperative imaging modalities, including contrast-enhanced CT, MRI, PET/CT and endoscopic ultrasound, in detecting occult peritoneal disease. In this era of personalized medicine and expanding loco-regional strategies such as cytoreductive surgery (CRS)/Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) and Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC), accurate staging is crucial. This study assessed the impact of SL and PW in high-risk GC. Methods: We retrospectively analyzed 113 consecutive high-risk GC patients who underwent SL and PW between 2014 and 2024 at our institution. The primary endpoint was detection of PM or positive cytology (CY+). Secondary endpoints were treatment modification, eligibility for loco-regional therapy, and safety. Results: SL/PW identified PM or CY+ in 26 patients (23%), including 16 with CY+ only. None had radiologic signs of peritoneal disease. SL findings altered treatment in all cases: 21 patients (81%) with Peritoneal Cancer Index (PCI) < 6 underwent induction chemotherapy followed by CRS + HIPEC; 5 patients (PCI > 6) were spared non-therapeutic laparotomy and treated with bidirectional systemic chemotherapy and PIPAC. In 10 patients, systemic therapy was shifted from FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) to FOLFOX (fluorouracil, leucovorin, and oxaliplatin) ± nivolumab. No perioperative complications occurred; all patients were discharged within 24 h without delay in systemic treatment. Conclusions: SL with PW is safe and significantly improves staging accuracy in high-risk GC, enabling personalized therapeutic planning. Routine integration of SL should be considered essential in treatment algorithms to guide systemic and loco-regional strategies. Full article

Background/Objectives: We aimed to evaluate the feasibility and safety of a combined approach to partial nephrectomy, which involves laparoscopic dissection for kidney as well as renal hilum mobilization, followed by robotic assistance for tumor resection and intracorporeal suturing, integrating the technical advantages of both laparoscopic and robotic surgery. Methods: We retrospectively analyzed 99 patients with clinical stage 1 renal tumors who underwent laparoscopic (LPN, n = 31), robot-assisted (RAPN, n = 16), or combined partial nephrectomy (CPN, n = 52) between 2016 and 2024. CPN involved laparoscopic mobilization of the kidney and renal hilum, followed by robotic tumor excision and intracorporeal suturing. Perioperative and postoperative outcomes were compared across groups. Results: Comparative analysis of the demographic characteristics of patients who underwent LPN, RAPN and CPN revealed no significant differences. The mean operative time (OT) was 126.75 ± 25.28 min for CPN, 121.9 ± 9.5 min for LPN (p = 0.014), and 155.5 ± 18.03 min for RAPN (p < 0.001). The median warm ischemia time (WIT) was 20.0 min (10.0–26.0) for CPN, which is comparable to RAPN at 18.5 min (14.0–23.0) (p = 0.158), but it was significantly longer for LPN at 23.0 min (18.0–28.0) (p < 0.001). The estimated blood loss (EBL) was 120.0 mL (50.0–350.0) for CPN, which is similar to RAPN at 110.0 mL (50.0–300.0) (p = 0.158), while it was higher for LPN at 180.0 mL (100.0–250.0) (p < 0.001). No major intraoperative or postoperative complications classified as Clavien–Dindo grade ≥3 were observed in any group. Conclusions: CPN is a feasible and safe approach for clinical stage 1 renal tumors, combining the efficiency of laparoscopy with the precision of robotics. Compared with LPN and RAPN, CPN showed comparable early oncological and functional results and had shorter operative duration and improved perioperative parameters. Full article

Objective: The objective of our study was to assess the oncological safety of uterine manipulators (UMs) in apparent early-stage (FIGO I-II 2009) endometrial cancer treated by minimally invasive surgery (MIS). Methods: Our single-center retrospective study includes patients who underwent endometrial cancer surgery for apparent early-stage disease by either laparoscopy or by robotic or laparoscopic-assisted vaginal hysterectomy from November 2012 to December 2020. Data on UMs, isolated tumor cells (ITCs), cytology, lymphovascular space invasion, free cancer cells in fallopian tubes, stage, histology and grade were collected. Primary and secondary outcomes were cancer recurrence and disease-specific death. Kaplan–Meier curves and multivariate logistic regression were used for statistical analysis. Results: A total of 930 women with early-stage endometrial cancer were included; 789 (84.8%) had hysterectomy with a uterine manipulator and 141 (15.2%) without. A total of 88% had endometrioid histology, 71.6% were grade 1 and 95.7% had stage I disease. A higher risk of recurrence was observed with the Hohl manipulator (HR: 2.83. 95% CI: 1.004–7.98 p = 0.0492) on univariate analysis. On multivariate analysis, neither UM was associated with recurrence. With a mean follow-up of 48 months (range 3–118), no effect was seen on disease-specific death in either Hohl or V-Care (HR: 1.66. 95% CI: 0.48–5.70 and HR:1.29. 95% CI: 0.33–4.98). In high-grade histologies, UMs were strongly associated with recurrence (HR: 12.1. 95% CI: 1.52–96.6 p = 0.019) and disease-specific death (HR: 10.2. 95% CI: 1.12–92.1 p = 0.032). Conclusions: The use of UMs in MIS for endometrial cancer was associated with higher rates of recurrence without affecting disease-specific death, except in high-grade histologies. Full article

Background/Objectives: This systematic review and meta-analysis evaluates the oncological safety and outcomes of minimally invasive versus open interval debulking surgery after neoadjuvant chemotherapy in advanced ovarian cancer, addressing whether laparoscopy represents a safe alternative to the standard open procedure. Methods: The Ovid/Medline, Pubmed, and Cochrane databases were systematically screened for studies investigating surgical resection status and/or patient survival after laparotomy compared to minimally invasive interval debulking surgery for FIGO stage III-IV ovarian cancer. A meta-analysis was performed using a random-effects model and risk of bias was assessed. Results: Overall, 14 observational and randomized studies published between 2015 and 2024 with a total of 16,578 patients (4310 laparoscopy and 12,268 laparotomy) were included. A complete cytoreduction to no visible tumour was achieved significantly more often after minimally invasive surgery compared to laparotomy (RR = 1.12; 95% CI [1.01, 1.23]; p = 0.03). Overall survival showed no significant difference between the two groups (HR = 0.81; 95%CI [0.64, 1.04]); progression-free survival was significantly more common after laparoscopy (HR = 0.67; 95% CI [0.48, 0.94]; p = 0.02; I² = 55%; p = 0.07). Patients undergoing minimally invasive surgery experienced significantly fewer postoperative complications (RR = 0.50; 95% CI [0.33, 0.76]; p ≤ 0.001), a lower mean blood loss (165 mL vs. 325 mL; SMD −0.58, 95% CI [−0.82, −0.35]; p ≤ 0.001), a shorter mean hospital stay (3 days vs. 5 days; SMD −0.79, 95% CI [−1.06, −0.52], p ≤ 0.001), and a faster initiation of adjuvant chemotherapy (mean 25 ± 32 days vs. 33 ± 28 days). Conclusions: This study indicates that laparoscopic interval debulking surgery is an oncologically safe alternative in selected patients with advanced-stage ovarian cancer. However, randomized controlled trials should confirm these findings as certainty of evidence is low and residual confounding cannot be excluded. Trial registration: PROSPERO Identifier CRD42024524725. Full article

A laparoscopic approach has been incorporated into the surgical management of a great variety of gynecologic pathologies during the decades following the first description of the method. As knowledge and experience about the use of laparoscopy is accumulating, it is gradually being recognized as an oncologically safe and effective option for the surgical management of various types of gynecological cancer, and the indications for its applications are increasing, as controversial topics are resolved through research. Endometrial cancer is the gynecological malignancy with the most straightforward indications of laparoscopy in its treatment, since a minimally invasive approach is considered the standard of care for both the surgical treatment of early-stage disease and surgical staging through sentinel lymph node biopsy. The role of laparoscopy was significantly decreased in the surgical management of cervical cancer after the publication of the LACC trial which reported worse survival outcomes for patients treated with laparoscopy, and laparotomy has emerged as the preferred approach. However, laparoscopy can be acceptable for carefully selected cases of early-stage cervical cancer and has also been introduced as an effective method for the surgical staging of the disease. The use of laparoscopy in the diagnostic and therapeutic management of ovarian cancer is not fully established but is receiving growing attention, as increasing evidence supports the safety of this approach, especially in the treatment of early-stage disease, where it is considered an acceptable alternative approach to laparotomy. Finally, as laparoscopic advancements are continuously achieved, new indications for laparoscopy have been explored for both vulvar and breast cancer. Future research will identify and highlight new ways to further integrate laparoscopy into the diagnostic and therapeutic management of gynecological malignancies. Full article