Gynaecological cancers represent a significant public health issue on a global scale, particularly impacting low- and middle-income nations [1]. In Cameroon, cervical cancer stands out as the most prevalent cancer affecting women. It is also the primary cause of cancer-related deaths among females, with an estimated incidence rate of 40.2 per 100,000 each year [2]. Historically, surgeons have depended on laparotomy for managing these cases, a method that often resulted in considerable morbidity. Patients frequently experienced substantial blood loss, intense post-operative pain, a heightened risk of infections, and extended recovery periods [3].

In the past thirty years, the landscape of surgical treatment has been transformed by the advent of minimally invasive surgery. Laparoscopy, which was initially employed for diagnostic and staging purposes, has rapidly established itself as the preferred method for treating various cancers, including early-stage endometrial cancer [4]. The existing international literature robustly supports its advantages. Numerous studies have demonstrated that laparoscopy achieves oncological results comparable to those of laparotomy. The key benefits of this approach include reduced blood loss, diminished post-operative discomfort, shorter hospital stays, and a quicker return to normal activities [5][6]. The extensive LAP2 randomized trial further validated these findings, confirming the safety and practicality of laparoscopic staging for endometrial cancer [7].

In sub-Saharan Africa, the implementation of advanced surgical techniques encounters significant challenges. Key obstacles include the unavailability of specialized equipment, the prohibitive costs of instruments, equipment maintenance, cost barriers, a steep learning curve for technical skills, and a lack of organized training programs [8]. Nevertheless, innovative practices are starting to surface from various African institutions, showcasing the potential for oncological laparoscopy within this unique context. A study conducted in Cameroon by Tempeen et al. [9] found that laparoscopic radical hysterectomy for early-stage cervical cancer led to fewer complications compared to the conventional laparotomy method. This outcome highlights laparoscopy as a safe and effective option. In Senegal, Diallo et al. [10] shared a successful experience with laparoscopic treatment of endometrial cancer, achieving perioperative outcomes that align with international standards. Although such studies remain uncommon, they reflect an increasing interest and capability for surgical advancement in the region.

The Yaoundé Gynaecology, Obstetrics and Paediatrics Hospital (HGOPY) stands out as a prominent gynaecology center in Cameroon. Recently, it has initiated a specialized programme for laparoscopic oncology surgery. Thus, assessing this developing practice has become crucial. Our study aims to outline the preliminary experience with laparoscopy for gynaecological cancers at HGOPY.

During the three-year recruitment period, 183 women underwent surgery for a gynaecological cancer. Of these procedures, 120 were performed via laparotomy. The remaining 63 surgeries used a laparoscopic approach. But 9 patients were excluded, and 54 were included. This represents a proportion of 29.5% for laparoscopy. The complete patient flow is detailed in Figure 1.

Figure 1.Patient flow diagram.

Our study found that 29.5% of surgeries for gynaecological cancers were performed laparoscopically. The global rate of laparoconversion stands at 6.1%, mainly for reasons related to uterine size >15 weeks. This result attests to the rapid integration of the technique into our centre’s therapeutic armamentarium. Our adoption rate surpasses that often documented in the initial experiences of other African institutions, both as a result of strong institutional commitment and increasing surgical know-how [10]. Leroux et al. reported in 2011 that 51.1% of procedures for gynaecological malignancies were performed via a laparoscopic approach in France [11]. Such a discrepancy is understandable, since laparoscopy has been recognized for more than two decades as a standard of care in France.

Our patient profile shows several important social determinants. This population was predominantly urban (75.9%) and highly educated (59.3%), suggesting that access to this advanced technology may be related to socioeconomic status. This is a common bias in resource-limited settings, where innovations often first reach the most informed and geographically accessible patients [12].

Although it is not an analytical study, the distribution of identified risk factors agrees with data in current epidemiological literature. In cervical cancer, the proportions of 66.7% early sexual intercourse. 93% history of STIs, and 75.8% multiparity confirm the known role of HPV and high parity among major risk factors for the disease [13]. The robust association we found between obesity and endometrial cancer is also widely reported as a result of peripheral hyperoestrogenism [14]. Nulliparity, likewise demonstrated in all our ovarian cancer cases is well recognized as a risk-enhancing factor for this malignancy [15].

In our series, ovarian cancer represented only 5.6% of the laparoscopic procedures. These were mainly performed for diagnosis and staging. This small percentage reflects the particular challenges of this malignancy. The indications for laparoscopy in ovarian cancer are mainly confined to the staging of suspected early-stage tumours and assessment of resectability [16]. Our patients presented with classic symptoms of pelvic heaviness (100%) and pain (66.7%), often associated with large masses. All these patients received neoadjuvant chemotherapy followed by cytoreductive laparotomy. The role of laparoscopy in ovarian cancer remains highly controversial, mainly due to the risk of cyst rupture and potential tumor spillage [17]. Gallotta et al., however, demonstrated that trained surgeons can safely use laparoscopy to select patients for primary cytoreduction without compromising oncologic outcomes compared to laparotomy [18]. In our environment, where all encountered cases were metastatic, the laparoscope was useful in diagnosis and staging without complications. Its extension to cytoreductive surgery must be approached with extreme caution and within the framework of prospective studies.

Endometrial cancer accounted for 33.4% of our series, a proportion likely to grow. The main risk factor is obesity, present in 66.7% of these patients, which also forms one of the most important technical challenges for minimally invasive surgery [14]. Despite this laparoscopy is now the standard for surgical staging of early-stage disease. as per international consensus [19]. The landmark LAP2 trial firmly established its feasibility and non-inferiority in terms of survival despite a higher conversion rate in obese patients [3]. This has been reinforced by studies like Janda et al., which found no difference in recurrence-free survival between approaches [5]. In our study, we performed total hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy in 83.3% of endometrial cancer cases without intraoperative complications. This confirms that, despite a high prevalence of obesity, laparoscopy is feasible and safe in the management of endometrial cancer in our practice.

Cervical cancer was the main indication for laparoscopy in our series (61.1%). In contrast, in high-income countries, this indication is usually surpassed by endometrial cancer, but our figure agrees with local epidemiology [2]. Laparoscopy is useful for the staging of locally advanced disease and for performing radical hysterectomy with lymphadenectomy in the early stages of the disease (FIGO IA2-IB1) [20]. However, the LACC trial created significant controversy, showing worse overall survival for minimally invasive radical hysterectomy compared to open surgery [21]. While several methodological criticisms exist, more recent studies. In particular, those who introduced the no-look, no-touch technique with a closed vaginal cuff have not found differences in oncological results [22]. The “no-look, no-touch” technique is a direct surgical response to the oncological risks highlighted by the LACC trial, and it is designed to mitigate the two primary mechanisms believed to cause tumor dissemination during conventional minimally invasive surgery: the mechanical disruption of the tumor by instruments and aerosolization of cells by the pneumoperitoneum. This can be achieved through two key principles: “no-touch” meaning avoid use of a uterine manipulator, which can crush the tumor and dislodge malignant cells. Instead, the uterus is handled only by its suppoting ligaments, preventing direct instrumentation near the cervix and its draining lymphatics, “no-look” refers to sealing and closure of the vagina before the colpotomy. This contains the tumor within a closed compartment, preventing the escape of exfoliated cells into the peritoneal cavity where they could implant. In the present series, the radical procedure was performed in 100% of the cases involving cervical cancer. The conversion rate was low (6.1%) and there were no complications. All tumours were less than 2 cm and we used the technique of vaginal cuff closure without uterine manipulator described by other authors [23][24]. Technical data support that mastering a rigorous, tumor-free technique is essential; our findings are associated with these. Thus, laparoscopy keeps an important place in cervical cancer management, particularly in regions with high incidence, where benefits from rapid recovery are very important. Its use must be guided. However, by rigorous selection of patients, informed consent with regard to the risks, and demonstrated surgical experience.

This is among the first studies detailing the practice of gynaecological oncological laparoscopy in Central Africa. We show significant adoption of this minimally invasive approach. Coupled with very favourable perioperative outcomes. Our study’s strengths reside in the fact that we provide. For the first time in the region. Accurate quantitative data that may serve as a benchmark for other centres. Limitations include the retrospective. Single-centre nature of our study design. The absence of information on long-term survival and quality of life is a limitation for a comprehensive oncological evaluation. Furthermore, while the cohort provides valuable insights. The small sample size for ovarian cancer (n = 3). limits the generalizability of our findings for this cancer. A further comparative study between laparoscopy and laparotomy would. In our context, provide stronger evidence to prove the benefit of the minimally invasive approach.

Our study confirms the feasibility and safety of laparoscopic surgery in gynaecological cancers. This finding holds true for Cameroon and holds relevance throughout the African continent. An adoption rate of 29.5% demonstrates the successful integration of this minimally invasive approach into our practice. The absence of major complications in the perioperative period and the short lengths of stay we observed further confirm its enormous benefits. The predominance of cervical cancer as the main indication is a relevant adaptation to our local epidemiological reality.

To continue this success, we suggest concrete recommendations for resource optimization and improvement of patient care. We emphasize that structured training programmes in minimally invasive techniques should be implemented without delay. Centres are to be provided with surgical equipment at the same time. There is a need for a prospective evaluation of long-term oncological outcomes now. Cost-effectiveness analyses are also required, which will be helpful for further health policies. Finally, this technique must be incorporated into the standardized multidisciplinary pathways of care for gynaecological malignancies.