In the late 1970s, laparoscopy began to be used in gynecologic surgery, and with the accumulation of operator experience, improvement of operating skills, and improvement of surgical instruments, the indications for laparoscopic techniques in gynecologic surgery were greatly expanded and contraindications were gradually reduced. in the 1990s, laparoscopic techniques gradually entered the field of gynecologic oncology. This review mainly describes the application of laparoscopy in the treatment of gynecologic tumors. The development of laparoscopy for gynecologic malignancies has gone through a long and tortuous process from the concept of laparoscopy to its widespread clinical application. 1795 Bozzine in Germany first proposed the idea of laparoscopy, but due to the limited technology at that time, only the rectum and uterus could be observed with a rectal endoscope. 1901 Kelling invented cystoscopy with Nitze, which could In 1910 Jacobaeus performed the first laparoscopic examination of a patient with ascites and named it “laparoscopy”. “Laparoscopy”. The first laparoscopic surgical procedure was performed by Fervers, a general surgeon, who reported the use of biopsy devices and cautery to loosen intra-abdominal adhesions laparoscopically. After this, obstetricians and gynecologists and internists made important contributions to the development of diagnostic and surgical laparoscopy until the early 1980s, with Boesch in Germany being the first to perform tubal sterilization using laparoscopic monopolar electrocoagulation in 1936 and Reich H performing the first laparoscopic total hysterectomy in 1985. Since then, laparoscopic surgery has entered an era of rapid development. From the 1960s to the 1970s, diagnostic laparoscopy and laparoscopic electrocoagulation for sterilization were widely used for the management of endometriosis, ectopic pregnancy, pelvic inflammatory masses, ovarian cysts, and other benign gynecological diseases. In 1992, Dargent and other experts in France reported laparoscopic pelvic lymph node dissection and laparoscopic-assisted transvaginal wide hysterectomy. In the same year, Nezhat et al. reported the first laparoscopic extensive hysterectomy + pelvic lymph node dissection in the United States. Since then, laparoscopic surgery has been gradually performed in the gynecologic oncology community for a long time, and has been catching up with the use of open surgery. As it has become more widely performed, there have been an increasing number of retrospective studies comparing laparoscopic surgery with open surgery. Observations from these studies include mean operative time, mean intraoperative bleeding, mean number of pelvic lymph nodes dissected, and type and number of postoperative complications. 2. Characteristics of laparoscopic surgery Laparoscopic surgery has been used in the field of gynecological surgery for more than 40 years since the 1970s, and with the improvement of operator skills and equipment, laparoscopic surgery has become increasingly accepted by gynecologists and patients. However, since laparoscopic surgery has been used in the field of gynecology various scholars have been controversial about the differences between its efficacy and that of open surgery, so there have been many large scale, multicenter systematic studies of the differences between the two since its inception. Observations from these comparative studies include: mean operative time, mean intraoperative bleeding, mean postoperative hospital stay, postoperative bowel recovery, mean number of lymph nodes dissected, and type and number of postoperative complications. As a result of these studies, it was suggested that laparoscopic surgery is not significantly different from and more advantageous than open surgery. In addition, laparoscopic surgery has the advantages of less trauma, faster recovery, and better visualization. Currently, with the maturation of laparoscopic techniques and equipment, the use of laparoscopic surgery in this procedure is gradually proving to be safe and effective. According to a large-scale, multicenter systematic study by GOG, laparoscopic surgery has been shown to have significant advantages over open surgery in terms of less patient pain, faster postoperative recovery, fewer postoperative complications, shorter average hospitalization days, and quality of survival at 6 weeks postoperatively in laparoscopic surgery compared to open surgery in the treatment of concurrent tumors. Intraoperative injuries and postoperative complications are uncommon in patients undergoing laparoscopic surgery, and one study noted that the incidence of intraoperative injuries in gynecologic laparoscopic surgery is approximately 0.1-10%. Secondly, a literature [7] pointed out that the main intraoperative injuries of laparoscopic surgery according to FDA from 1980 to 1999 included: pneumoperitoneum-related injuries, vascular injuries, intestinal injuries, urinary system injuries, and nerve injuries; postoperative complications included lymphatic cysts, hematomas, shoulder and neck pain, urinary difficulties, and edema. The incidence of these injuries and postoperative complications is usually low, with surveys showing that the incidence of visceral injuries is 0.3-1.3 per 1000 cases, while the incidence of vascular injuries is 0.07-4.7 per 1000 cases. There was no significant difference between the two compared to open surgery. Compared to laparoscopic surgery, open surgery also carries a risk of incisional complications, such as cellulitis in open versus laparoscopic incisions, which is 16% versus 7%. This means that laparoscopic surgery does not have more complications or a higher chance of occurrence than open surgery, and in many respects it is far less dangerous for the patient than open surgery. Of course, some rare complications have been reported in recent years, for example, Cucinella G et al. found that the use of morcellator for total hysterectomy was more likely to replace parasitic fibroids than conventional total hysterectomy in a three-year follow-up of patients after laparoscopic total hysterectomy. 3, specific application of laparoscopy in gynecological tumors In recent years, due to epidemiological changes, gynecological malignant tumors are gradually developing into common gynecological diseases, so it is extremely important to achieve early detection and early treatment. Since laparoscopic surgery was applied to the treatment of gynecologic malignant tumors in the 1990s, from its initial use as an examination device only, the indications for laparoscopic surgery have been greatly expanded with the improvement of technical operation skills and equipment, and now it has been widely used in the surgical treatment of endometrial cancer, cervical cancer and ovarian cancer. 3.1. Application of laparoscopy in the treatment of endometrial cancer Endometrial cancer is one of the common tumors of reproductive organs, accounting for 20%-30% of malignant tumors of female reproductive organs. Compared with other malignant tumors, endometrial cancer has a relatively slow development and less threatening course, and the prognosis of early treatment is better. In addition, the physiological characteristics of endometrial cancer determine that it grows slowly and can be confined to the uterine cavity for an initial period of time. Therefore, for the treatment of endometrial cancer, the international and domestic consensus is early surgery, and the surgical pathological staging formulated by FIGO for endometrial cancer is also based on complete surgery. The standard procedure is: extrafascial hysterectomy + bilateral adnexal resection + pelvic lymph node dissection + para-aortic (retroperitoneal) lymph node dissection. Although most endometrial cancers are detected at an early stage and can be cured with standard radical surgery, however, most of these patients are also found to have a combination of risk factors that increase the risk of surgery, such as advanced age, obesity, diabetes, and hypertension. The AGO has stated that laparoscopic lymph node dissection in patients with endometrial cancer appears to be much safer than open lymph node dissection. Currently, laparoscopic surgery for endometrial cancer is used in three main areas: (1) total extrafascial hysterectomy + bilateral adnexal resection + lymph node dissection; (2) staged surgery after total hysterectomy; and (3) evaluation of recurrence. Various studies over the years have shown no significant differences between laparoscopic and open surgery in terms of operative time, number of lymph nodes removed, chance of complications, chance of postoperative recovery, and likelihood of recovery: Tozzi et al. compared the number of lymph nodes removed in patients with endometrial cancer undergoing open surgery and laparoscopic surgery for pelvic lymph node and para-aortic lymph node dissection. The numbers of pelvic lymph nodes were (15.4±7.6) and (16.1±7.6), respectively (P>0.05), and the numbers of para-aortic lymph nodes were (8.4±6.4) and (9.6±4.7), respectively (P>0.05), and the differences were not statistically significant. Of course, in recent years, Nezhat et al also compared nearly 200 patients undergoing laparoscopic and open surgery for stage I and II endometrial cancer to show that patients undergoing laparoscopic surgery had less intraoperative bleeding, faster postoperative recovery, and shorter hospital stay. In other words, laparoscopic surgery can give patients a better quality of life after surgery. Thus, laparoscopic radical endometrial cancer surgery has become a routine procedure. Of course, some scholars have now suggested that laparoscopic total hysterectomy has a risk of causing recurrence of endometrial cancer in the vaginal stump, but there are no large-scale randomized controlled trials to demonstrate a direct relationship between vaginal stump recurrence and laparoscopic surgery, nor are there studies showing that laparoscopic surgery is more likely to cause stump recurrence than open surgery. Some patients are found to have endometrial cancer after total hysterectomy, and these patients often require a single in-stage procedure, laparoscopic restaging, which is one of the important applications of laparoscopy. data from GOG studies suggest that laparoscopic surgery is one of the safe and effective ways to perform restaging. 3.2. Application of laparoscopy in the treatment of cervical cancer Cervical cancer is one of the most common malignancies in women, and it is the second most common malignancy after breast cancer. In recent years, due to the spread and dissemination of sexually transmitted diseases, the incidence of HPV infection is gradually increasing, and the incidence of cervical cancer is also gradually increasing and becoming younger. Early laparoscopic surgery is mainly aimed at the pathological staging of advanced cervical cancer. With the development of laparoscopic technology and the increasing maturity of the operator’s operation technique, coupled with the results of some clinical studies suggesting that laparoscopic surgery is effective for the surgical treatment of cervical cancer, laparoscopic surgery has gradually become an important means of clinical cervical cancer treatment. At present, there are two main applications of laparoscopy in cervical cancer: one is laparoscopic surgical treatment of cervical cancer. The scope and indications of laparoscopic radical resection for cervical cancer are basically the same as those of open surgery, and because the surgical field of view of laparoscopy is better than that of open surgery, laparoscopic operation for deep lymph node dissection below the closed nerve, which was impossible in the era of open surgery, has gradually become a routine operation. Secondly, it assists in the pathological staging of invasive cervical cancer. Lymph node metastasis is an important risk factor for cervical cancer, and it has been reported that 7%-15% of early invasive cervical cancers have lymph node metastasis, so pelvic lymph node and para-aortic lymph node dissection has become an important part of cervical cancer staging. The presence or absence of metastases in the pelvis, abdominal organs and retroperitoneal lymph nodes by laparoscopic examination and lymph node dissection can give direction for postoperative radiotherapy. In addition, the faster recovery of intestinal function and lighter intra-abdominal adhesions after laparoscopic surgery provide convenience for postoperative radiotherapy. A comparison has been made between 11 cases of radical laparoscopic cervical cancer surgery and 29 cases of adjuvant radiotherapy after open radical cervical cancer surgery for radiation bowel injury. The median dose of radiotherapy used in both groups was 50.4 Gy, and the follow-up time was 13 months. The results showed that grade II-IV radiation small bowel injury occurred after laparoscopic radiotherapy. 3.3. Application of laparoscopy in the treatment of ovarian tumors Ovarian tumors include benign tumors, junctional tumors, and malignant tumors. For pelvic masses of unknown nature, the nature can be clarified by laparoscopic exploration. Some scholars reported that only 53% of patients with clinical suspicion of malignant tumors were confirmed by laparoscopic exploration, making these patients avoid the damage of open abdomen. Ovarian junctional tumor is a kind of tumor between benign tumor and malignant tumor. It has abnormal proliferation but does not exactly have the nature of malignant tumor, and it mostly occurs in younger women or women of reproductive age. Most of the intersecting tumors have a good prognosis, but still have a recurrence rate of 10-20%. In women of childbearing age, cyst excision is often performed to protect their reproductive function, thus allowing the ovaries to retain their function. However, women who undergo cystectomy still have a high risk of recurrence. However, this risk is not only present in laparoscopic surgery, but also in open surgery, and studies have shown that there is no significant difference between the two. Of course, there are reports that the likelihood of cyst rupture during laparoscopic cystectomy is greater than that of open surgery, but there are no studies that indicate that this increases the chance of cyst recurrence. However, because of the recurrence-prone nature of ovarian junctional tumors and the fact that most studies indicate that the chance of recurrence after exenteration is greater than that of unilateral adnexal resection, the indications for laparoscopic tumor exenteration, even though it is already a routine clinical procedure, must be strictly controlled, i.e., patients with unilateral ovarian junctional tumors or bilateral ovarian junctional tumors that require preservation of reproductive function. The incidence of ovarian cancer is the third most common malignant tumor in female reproductive system, but the mortality rate is the first. One of the reasons for its high mortality rate is that the ovarian growth site is hidden and cannot be seen directly, and there are few early symptoms, so when it is detected, it is often at an advanced stage. Laparoscopic treatment for early-stage ovarian cancer has been controversial at home and abroad, but recent studies have suggested that laparoscopic surgery has positive implications for the treatment of early-stage ovarian cancer. The FIGO guidelines state that complete staging of ovarian cancer should include total hysterectomy, bilateral adnexal resection, greater omentectomy, pelvic lymph node dissection, and laparotomy. In a cohort study of patients undergoing laparoscopic and open ovarian cancer staging, Chi et al. showed that there was no significant difference in the size of greater omental resection and the number of lymph nodes dissected, but the laparoscopic group had significantly less bleeding and length of stay in the hospital than the open group. Laparoscopic ovarian cancer staging was first used in 1994, and since then, this procedure has gradually become a routine clinical procedure. With the gradual maturation of laparoscopic surgery technology, it is now also used in advanced ovarian cancer. It is mainly manifested in the following three aspects: (1), assessment of the possibility of surgery: Fagotti et al. counted 64 patients who were evaluated by laparoscopic exploration followed by open surgery and compared the results with patients who underwent direct open surgery. He found that patients evaluated laparoscopically for the ability to perform tumor reduction had even a 100% chance of successful reoperation. （Littell et al. showed that if the laparoscopic secondary exploration was negative, the chance of a negative open exploration was about 91.5%. (3) Tumor cell reduction: Although few studies have been reported on laparoscopic tumor reduction. However, in 2008, Nezhat published his own prospective study of laparoscopic first or second tumor reduction, in which he divided 32 patients into two groups: 13 patients who underwent first tumor reduction and 19 patients who underwent second/third tumor reduction in the second group. Observations were operative time, bleeding volume, and in addition these two groups of patients received 13.7 months and 29.6 months of follow-up, respectively. Although this report suggests the feasibility of laparoscopic surgery in tumor reduction, more clinical trials are needed to confirm the use of laparoscopy in tumor reduction. 4. Prospects for the development of laparoscopic surgery in China In the late 1970s and early 1980s, Lang Jinghe et al. first published “Application of laparoscopy in clinical diagnosis of gynecology” in China, and in 1993, Zhang Airong et al. completed the first case of laparoscopic hysterectomy in China. The clinical application of laparoscopy is becoming more and more widespread and is also receiving more and more attention, and now it has become increasingly popular in large and medium-sized cities in China. At present, more than 70% of classical open gynecological surgery has been replaced by laparoscopy in China. With the improvement of skills and experience of laparoscopic operators and the continuous improvement of laparoscopic equipment in major hospitals in China, laparoscopic lymph node dissection for malignant tumors has been gradually carried out in recent years. Through these years, the indications for laparoscopic surgery have been gradually expanded and contraindications have been greatly reduced, and some scholars even believe that there is no absolute contraindication for laparoscopic surgery. Furthermore, with the rapid development of robotic surgery in the field of surgery internationally, robotic surgical systems in the field of gynecological surgery have also been gradually promoted and have led to a certain awareness among gynecologists in China. It is believed that in the near future robotic surgery systems will also be carried out in major hospitals in China.