Caution: minimally invasive radical hysterectomy for early cervical cancer

This caution pairing concerns minimally invasive, laparoscopic or robotic, radical hysterectomy for early cervical cancer. Although keyhole surgery is less painful, the phase 3 LACC trial found that it led to more recurrences and more deaths than open radical hysterectomy, and large cohort studies have confirmed the finding. The leading explanation is that laparoscopic manipulation of the cervix disseminates tumour cells, with carbon dioxide insufflation and the uterine manipulator the suspected culprits. Open surgery is therefore the standard, while the RACC and ROCC trials test whether manipulator-free techniques with vaginal closure can make the minimally invasive approach safe.