Obstetrics and Gynecology International laparoscopy in their surgical practice. Laparoscopic hysterec- tomy for endometrial cancer staging was the most frequent procedure performed (43%) [71]. 6.3. Robotic-Assisted Surgical Approach. Since 2005, there has been a considerable increase in the published literature describing the use of robotic-assisted surgery for endometrial cancer staging [70–84]. When compared to laparotomy, the robotic-assisted surgery had signiﬁcantly longer mean operative time, but lymph node yields were comparable to the open surgery. The length of hospital stay, blood loss, and postoperative complication rates were signiﬁcantly lower for robotically operated patients [79, 80]. Boggess et al. compared three surgical methods for endometrial cancer staging: laparotomy, laparoscopy, and robotic-assisted approach. Patients operated by robotic tech- nique had shortest hospital stay, lowest estimated blood loss, and highest lymph node yield. Operative time was the longest for laparoscopy followed by robotics, with a similar laparo- tomic conversion rates for robotic and laparoscopic groups [81]. Robotic-assisted approach has been also proposed as a good and feasible option for comprehensive surgical staging in obese women with endometrial cancer [82]. Moreover, this technique may have particular advantages for both the obese and morbidly obese patients aﬀected with endometrial cancer, when compared to laparoscopic approach [83, 84]. 7. Conclusions Surgical staging for endometrial cancer represents certain beneﬁts: ﬁrstly, it is the gold standard to assess the disease extent. Secondly, it also has a prognostic role and guides for further treatment. The therapeutic value of lymphadenec- tomy has not been proven in prospective studies, especially in low-risk cases at preoperative staging. There are many predictors of lymph nodes involvement useful to evaluate patient’s risk categories and to guide surgical management. TVS and MRI may accurately detect the depth of myometrial invasion and cervical spread of the disease, but preoperative imaging cannot accurately assess lymph node involvement. Intraoperative assessment of node involvement and myometrial invasion does not have the sensitivity and speciﬁcity to select women who can avoid lymphadenectomy from the surgical procedure. A great challenge in surgical management of endome- trial cancer is standardisation of pelvic and paraaortic lymphadenectomy strategies, in order to avoid unnecessary procedures and to oﬀer complete staging with high survival rates. The morbidity of lymphadenectomy appears to be reduced with the use of laparoscopy. Numerous trials have demonstrated the safety and feasibility of laparoscopy in complete surgical staging for early stages of endometrial cancer with similar nodes yields, recurrence and survival outcomes. As expected, signiﬁcant improvements in early and late postoperative complications, a shorter hospital stay, a better quality of life, and less overall treatment costs were demonstrated in many comparative studies between 5 laparotomy and laparoscopy. Laparoscopic approach is safe and feasible also in obese and elderly woman with early stage endometrial cancer, with low rate of conversion, shorter hospital stay, and a faster return to full activity compared with laparotomy. The role of robotics in endometrial cancer staging continues to evolve and has yet to be determined deﬁnitively. Most studies about robotic surgery show that it is a feasible and safe option, especially for obese patients. References [1] A. Jemal, T. Murray, E. Ward et al., “Cancer statistics, 2005,” CA: A Cancer Journal for Clinicians, vol. 55, no. 1, pp. 10–30, 2005. [2] P. J. Frederick and J. M. Straughn Jr., “The role of compre- hensive surgical staging in patients with endometrial cancer,” Cancer Control, vol. 16, no. 1, pp. 23–29, 2009. [3] K. Galaal, A. Fisher, F. Kew, and A. Lopes, “Laparoscopy versus laparotomy for the management of endometrial cancer,” Cochrane Database of Systematic Reviews, no. 3, Article ID CD006655, 2007. [4] J. Morrison, K. May, R. Srinivasan et al., “Lymphadenec- tomy for the management of endometrial cancer,” Cochrane Database of Systematic Reviews, no. 1, Article ID CD007585, 2009. [5] W. T. Creasman, C. P. Morrow, B. N. Bundy, H. D. Homesley, J. E. Graham, and P. B. Heller, “Surgical pathologic spread patterns of endometrial cancer. A gynecologic oncology group study,” Cancer, vol. 60, no. 8, pp. 2035–2041, 1987. [6] M. Q. Bernardini and J. K. Murphy, “Issues surrounding lymphadenectomy in the management of endometrial cancer,” Journal of Surgical Oncology, vol. 99, no. 4, pp. 232–241, 2009. [7] S. Pecorelli, “Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium,” International Journal of Gynaecology and Obstetrics, vol. 105, no. 2, pp. 103–104, 2009. [8] W. Creasman, “Revised FIGO staging for carcinoma of the endometrium,” International Journal of Gynecology and Obstetrics, vol. 105, no. 2, p. 109, 2009. [9] H. S. Kim and Y. S. Song, “International Federation of Gynecology and Obstetrics (FIGO) staging system revised: what should be considered critically for gynecologic cancer?” Journal of Gynecologic Oncology, vol. 20, no. 3, pp. 135–136, 2009. [10] A. Mariani, S. C. Dowdy, and K. C. Podratz, “New surgical staging of endometrial cancer: 20 years later,” International Journal of Gynecology and Obstetrics, vol. 105, no. 2, pp. 110– 111, 2009. [11] J. K. Chan and D. S. Kapp, “Role of complete lymphadenec- tomy in endometrioid uterine cancer,” Lancet Oncology, vol. 8, no. 9, pp. 831–841, 2007. [12] K. Y. Look, “Role of lymphadenectomy in management of adenocarcinoma of the endometrium,” European Journal of Gynaecological Oncology, vol. 25, no. 5, pp. 545–551, 2004. [13] J. K. Chan, M. K. Cheung, W. K. Huh et al., “Therapeutic role of lymph node resection in endometrioid corpus cancer: a study of 12,333 patients,” Cancer, vol. 107, no. 8, pp. 1823– 1830, 2006. [14] C. P. Morrow, B. N. Bundy, R. J. Kurman et al., “Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a