Computer-assisted and image-guided surgery for surgical lymph-nodal staging of gynecologic cancer in the era of digital and robotic surgery: a review of current evidence.

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Abstract

Accurate lymph node staging is central to prognostic stratification and therapeutic decision-making in gynecologic oncology. Yet, conventional systematic lymphadenectomy frequently results in excessive treatment for node-negative patients, who represent the majority of cases, and is associated with significant morbidity. This review highlights how digital and imaging technologies are redefining intraoperative lymph node assessment. Real-time optical biopsies with full-field optical coherence tomography or high-frequency ultrasound, coupled with artificial intelligence-assisted image analysis, promise to enhance the precision, efficiency, and safety of nodal evaluation. Although the impact of robotic-assisted laparoscopy on oncologic outcomes compared with conventional approaches remains debated, its role as a versatile platform for the integration of digital assistance tools is steadily expanding. The convergence of these innovations is driving a shift from extensive dissections to selective, image-guided interventions to detect micrometastases intraoperatively. Ultimately, advances in intraoperative imaging and AI may make nodal excision unnecessary when a reliable negative assessment can be achieved. This paves the way for smart operating rooms where technology and surgical expertise converge to deliver safer, more efficient, and personalized oncologic care. This work was supported by French state funds managed by the ANR within the 'Programme d'investissements d'avenir' France 2030 (reference ANR-10-IAHU-02).

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