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For those with certain recurrent gynaecological cancers where primary management such as chemo-radiotherapy has failed, or in cases of recurrence following primary surgery, pelvic exenteration (PE) is considered the only curative option. Whilst initially considered a morbid procedure, improved surgical techniques, advancing technology, and nuanced reconstructive options have facilitated more radical resections and improved morbidity and mortality. Open PE remains the gold standard approach, however, minimally invasive techniques for PE may lessen morbidity whilst achieving the same oncological outcomes. The objective of this study was to assess the feasibility and safety of minimally invasive PE with a laparoscopic or robot-assisted approach. We also performed a review of the literature on robot-assisted PE which has not been widely reported for cases of recurrent gynaecological malignancy. Between 2015 and 2021six minimally invasive PE were performed. All patients underwent extensive multi-disciplinary assessment and counselling pre-operatively. Patient characteristics, treatment indication, perioperative data, short-term complications, and histological outcomes were recorded. There were two anterior exenterations, three posterior exenterations and one total exenteration performed. The primary cancer stage varied from stage 1a-3b. Five out of six patients had pre-operative chemo-radiotherapy. The average operative time (including surgical docking) was 600 min. Mean blood loss was 400 mL and the average length of stay was eight days. Enhanced recovery practices were used where possible. There were no intraoperative complications and one major post-operative complicationwhich was breakdown of an inferior gluteal artery perforator flap perineal reconstruction. All patients had negative margins at post-operative histopathology. All patients are alive and recurrence free at follow-up, but long-term outcome data is needed. This initial case series suggest that minimally invasive pelvic exenterationcan feasibly be performed in place of open pelvic exenteration. Furthermore, our findings suggest this may be a safe alternative as we report similar findings to the existing literature, however no firm conclusions can be drawn at such an early stage. Long term follow-up data and a larger cohort study will be needed to establish non-inferiority to open PE., (Crown Copyright © 2022. Published by Elsevier B.V. All rights reserved.)

On March 11, 2020 the COVID-19 outbreak was declared a 'pandemic' by the World Health Organization. COVID-19 is associated with higher surgical morbidity and mortality. An array of guidelines on the management of cancer during this pandemic have been published since the first reports of the outbreak. This narrative review brings all the relevant information from the guidelines together into one document, to support patient care. We present a detailed review of published guidelines, statements, comments from peer-reviewed journals, and nationally/internationally recognized professional bodies and societies' web pages (in English or with English translation available) between December 1, 2019 and May 27, 2020. Search terms included combinations of COVID, SARS-COV-2, guideline, gynecology, oncology, gynecological, cancer. Recommendations for surgical and oncological prioritization of gynecological cancers are discussed and summarized. The role of minimally invasive surgery, patient perspectives, medico-legal aspects, and clinical trials during the pandemic are also discussed. The consensus is that elective benign surgery should cease and cancer surgery, chemotherapy, and radiotherapy should continue based on prioritization. Patient and staff face-to-face interactions should be limited, and health resources used efficiently using prioritization strategies. This review and the guidelines on which it is based support the difficult decisions currently facing us in gynecological cancer. It is a balancing act: limited resources and a hostile environment pitted against the time-sensitive nature of cancer treatment. We can only hope to do our best for our patients with the resources available to us., Competing Interests: Competing interests: SB-M: Proctor for Intuitive Surgical and Plasma Surgical and Ethicon. JC: Occasionally gives paid lectures on behalf of pharmaceutical companies. AS: Honorarium from Elekta. AM: Educational grants from Clovis, GSK, Ipsen, Novartis, Pfizer, and Tesaro., (© IGCS and ESGO 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The paper discusses the setup and evaluation of early data following the establishment of a robotic surgery programme in a UK gynaecological oncology cancer centre., Methods: Prospective data were collected between December 2009 and December 2011 for all women undergoing robotic assisted procedures within the gynaecological oncology department. Patient demographics, intra, peri and post-operative data were collected at a single institution, which is a tertiary referral centre for gynaecological oncology and minimal access surgery., Results: In total, 104 robotically assisted cases were performed within the gynaecological oncology team. The procedures undertaken included simple and radical hysterectomy, radical trachelectomy, BSO following previous hysterectomy, pelvic and para-aortic node dissection and omentectomy. The mean blood loss was 155.24 mL and the mean hospital stay was 3 days with more than half the women being discharged on day 1 post surgery., Conclusions: These data suggest that robotic assisted surgery is well suited to treating women with principally endometrial and cervical cancers and selected cases of ovarian cancer, enabling surgical staging to be completed with many more patients benefitting from a minimal access surgery approach. Thorough preparation, appropriate case selection and preceptorship in robotic surgery is essential to minimize the associated risks associated with adopting new surgical techniques., (Copyright © 2012 John Wiley & Sons, Ltd.)

We evaluated the effectiveness and safety of Quixil in gynaecological oncology with a prospective observational study over 11 months in a gynaecological oncology centre. Quixil was opportunistically used when conventional haemostatic techniques failed, in 35 laparotomies and four laparoscopies. A total of 26 operations were performed for malignant disease and 13 for benign indications. Demographic, intraoperative and postoperative data were collected. Haemostasis was accomplished within 5 min from sealant application. No hypersensitivity reactions were noted. Bowel recovery and postoperative pain were usual. In the laparotomy group, the mean hospital stay was 11 days and mean operating time, 164 min. In the laparoscopy group, the mean hospital stay was 3 days and mean operating time 165 min. In both groups, the incidence of complications and recurrence rates were in line with the expected population rates of these treated patients. We conclude that Quixil is an efficient, safe and effective haemostatic agent, which has a role to play in gynaecological surgery for benign and malignant disease.