The evolution of gynaecological surgery has undergone a massive change in the past thirty years with the introduction of operative laparoscopy and robotic surgery. Surgical procedures such as complex endometriosis surgery and cancer surgery have evolved to a level where the decision about mode of surgery has almost turned on its head and many patients, especially with hysterectomy for cancer of the cervix or uterus, will be candidates for endoscopic management rather than a reflex open surgical option.
Massive changes in technology have allowed this to occur, resulting in changes in peri-operative morbidity, especially in the morbidly obese, and a reduction in debilitating wound infections and subsequent incisional hernia development.
The future for endoscopic surgery is indeed bright and will continue to evolve with improving technology and, in particular, sophisticated retrieval systems for specimen removal. The challenges of morbid obesity continue to be the biggest impediment to successful endoscopic surgery.