Functional Preservation in Minimally Invasive Gynecological Surgery: Balancing Radicality, Autonomic Nerve-Sparing, and Quality of Life

Minimally invasive and robotic techniques have transformed gynecological surgery by improving visualisation, surgical access, perioperative recovery, and the precision of complex pelvic procedures. However, technical feasibility and short-term surgical outcomes do not fully capture the success of an operation. In gynecologic oncology and advanced pelvic surgery, the extent of resection must be balanced with preservation of the neural, urinary, bowel, sexual, reproductive, and endocrine functions that shape long-term health and quality of life.This Research Topic will examine the surgical applications of functional preservation across minimally invasive gynecological surgery. It will address how nerve-sparing principles are translated into operative planning, anatomical dissection, tissue handling, reconstruction, intraoperative decision-making, and postoperative care. The collection will be relevant to procedures including radical hysterectomy, radical trachelectomy, parametrial resection, pelvic lymphadenectomy, pelvic sidewall surgery, endometriosis surgery, prolapse and pelvic-floor procedures, fertility-sparing operations, and other complex laparoscopic, robotic, single-port, and vaginal interventions.Autonomic nerve-sparing surgery has become an important part of this discussion. Procedures involving the hypogastric nerves, pelvic splanchnic nerves, inferior hypogastric plexus, pelvic sidewall, bladder, bowel, and reproductive organs may affect urinary, bowel, sexual, fertility, ovarian, and endocrine function. The challenge is to preserve function without compromising oncologic safety, anatomical completeness, or appropriate disease control.We welcome research that connects surgical anatomy, operative technique, imaging, technology, pathology, oncologic outcomes, rehabilitation, survivorship, and patient-reported outcomes. Relevant studies may evaluate surgical approaches, anatomical landmarks, dissection planes, nerve identification, reconstruction methods, intraoperative guidance, learning curves, surgical training, and perioperative pathways that support functional recovery.The collection aims to move beyond a narrow comparison of open and minimally invasive approaches. Instead, it will consider which surgical techniques, technologies, patient-selection criteria, and multidisciplinary care pathways achieve the best balance between radicality and preserved function. Research addressing fertility and ovarian preservation is welcome when it is linked to surgical decision-making, oncologic safety, autonomic or pelvic functional preservation, and longer-term patient outcomes. The focus is not on fertility preservation alone, but on the broader functional consequences and clinical applications of complex gynecological surgery.We welcome contributions from gynecologic oncologists, minimally invasive and robotic surgeons, urogynecologists, colorectal and pelvic surgeons, anatomists, radiologists, pathologists, medical oncologists, physiotherapists, rehabilitation specialists, psycho-oncology teams, reproductive medicine specialists, surgical educators, methodologists, and people with lived experience of gynecological surgery.Topics of interestSubmissions may address, but are not limited to, the following themes:• Surgical anatomy and operative principles of pelvic autonomic nerve-sparing• Nerve-sparing radical hysterectomy and radical trachelectomy• Functional preservation during parametrial, paravaginal, pelvic sidewall, and extended pelvic surgery• Minimally invasive, robotic, single-port, and vaginal approaches to complex gynecological procedures• Surgical applications of nerve mapping, fluorescence, imaging, navigation, augmented reality, and artificial intelligence• Preoperative imaging and three-dimensional anatomical planning for function-preserving surgery• Surgical landmarks, dissection planes, tissue handling, and technical variations that influence pelvic function• The relationship between surgical radicality, resection margins, lymph-node assessment, recurrence, and functional outcomes• Bladder dysfunction, urinary retention, incontinence, constipation, faecal dysfunction, and other postoperative functional consequences• Sexual function and pelvic-floor outcomes after gynecological surgery• Fertility and ovarian preservation in the context of oncologic and minimally invasive surgery• Reconstructive and restorative surgical techniques that support functional recovery• Surgical treatment and functional outcomes in endometriosis, pelvic-floor disorders, prolapse, and complex benign pelvic disease• Patient-reported outcome measures and validated tools for assessing quality of life and pelvic function• Long-term survivorship after gynecologic oncology surgery• Pelvic-floor physiotherapy, rehabilitation, sexual health care, and multidisciplinary recovery pathways• Shared decision-making and counselling about surgical risks, functional outcomes, and recovery• Patient selection and risk stratification for nerve-sparing or function-preserving procedures• Learning curves, simulation, mentorship, credentialing, and surgical education in nerve-sparing techniques• Comparative studies of open, laparoscopic, robotic, single-port, and vaginal surgical approaches• Prospective cohorts, registries, multicentre studies, and real-world evidence on surgical outcomes• Systematic reviews, meta-analyses, consensus statements, and evidence-based surgical frameworks• Health-economic and implementation studies related to functional-preservation surgery and survivorship care Topic editors: Stefano Cianci, Carlo Ronsini Source: https://www.frontiersin.org/research-topics/86859/functional-preservation-in-minimally-invasive-gynecological-surgery-balancing-radicality-autonomic-nerve-sparing-and-quality-of-life