# Caution: minimally invasive radical hysterectomy for early cervical cancer

Source: https://onco.cc/pairings/caution-mis-radical-hysterectomy/  
OnCo record `caution-mis-radical-hysterectomy` (Pairing). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Keyhole radical hysterectomy, though less painful, led to more recurrences and deaths than open surgery in the LACC trial. Open surgery is the standard until protective techniques are proven.

## Summary

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.

## Fields

- Kind: Pairing
- Last checked: 2026-09-07
- Pairs: Robotic & minimally invasive surgery + Cervical cancer
- Type: caution
- Rationale: Laparoscopic manipulation of the cervix is thought to disseminate tumour cells.
- Evidence: Phase 3 (negative for MIS) plus large cohorts.

## Sources

- ClinicalTrials.gov NCT00614211: LACC (Laparoscopic Approach to Cervical Cancer): https://clinicaltrials.gov/study/NCT00614211

## Connected records

- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/), [Early cervical cancer and fertility-sparing surgery](https://onco.cc/cancers/early-cervical-cancer/)
- technologies: [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/)
- trials: [LACC (Laparoscopic Approach to Cervical Cancer)](https://onco.cc/trials/lacc/)

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