Minimally invasive surgery in gynecologic oncology: a narrative review of controversies and clinical implications.

Background and Objective: Minimally invasive surgery (MIS) has changed the surgical approach of many gynecologic malignancies, offering benefits such as reduced blood loss, shorter hospitalization and quicker recovery. While laparoscopic and robotic-assisted approaches are well established in the treatment of endometrial cancer, their role in cervical and ovarian cancer remain less clear. This review discusses the evolution and key controversies of MIS in gynecologic oncology. We will evaluate recent data and ongoing clinical trials that examine the use of MIS across cervical, endometrial, and epithelial ovarian cancers. Methods: A literature review was conducted using PubMed from January 2000 through April 2025 to identify relevant peer-reviewed studies. Only English language publications were included. Randomized controlled trials and retrospective cohort studies focused on MIS in gynecologic oncology were included. Ongoing clinical trials were identified through ClinicalTrials.gov. Studies were selected based on relevance, methodological rigor and impact on clinical practice. Key Content and Findings: The Laparoscopic Approach to Cervical Cancer (LACC) trial and subsequent population-based studies raised concerns of inferior survival outcomes with minimally invasive hysterectomy for early-stage cervical cancer. This prompted a shift in clinical practice to abdominal radical hysterectomy for cervical cancer, and also led to new randomized trials, such as Robotic versus Open RadicalHysterectomy for Cervical Cancer (ROCC) and Robotic-assisted Approach to Cervical Cancer (RACC), to reassess oncologic safety. The Laparoscopic Approach to Carcinoma of the Endometrium (LAP2) and Laparoscopic Approach to Cancer of the Endometrium (LACE) trials established MIS as the standard of care for early-stage endometrial cancer, demonstrating comparable survival outcomes and fewer complications. In advanced ovarian cancer, the LANCE trial and multiple retrospective series suggest that MIS is feasible and safe for interval cytoreductive surgery in specific patient populations, however more data is needed for clinical generalizability. Conclusions: MIS is an important tool in modern gynecologic oncology. Its use continues to evolve, particularly in the context of cervical and ovarian cancers. Ongoing trials will clarify its role in oncologic outcomes.