Paweł Basta | Acting Head, Department of Gynaecology and Gynaecological Oncology, University Hospital, Kraków; Chair of Gynaecology and Obstetrics, Jagiellonian University Medical College, Kraków, Poland
Citation: EMJ. 2026; https://doi.org/10.33590/emj/19N9K1ZT
Minimally invasive surgery has transformed the management of many gynaecological conditions, but its role in cancer care remains complex. Where do you think its boundaries currently lie in gynaecological oncology?
I think we are moving those boundaries quite substantially, particularly with robotic surgery. In my view, robotic access improves our ability to perform radical surgery compared with conventional laparoscopy.
In the department I currently lead, we started performing robotic procedures for ovarian cancer around 2 years ago. Our experience is developing, and I think our ability to undertake these procedures will continue to improve.
Advanced endometriosis can require complex surgery close to the bowel, bladder, ureters, and major vessels. Which patients benefit most from surgery, and when might more extensive intervention cause more harm than benefit?
Treatment selection in endometriosis is, in some ways, more sensitive than in cancer care. In oncology, we have clear guidelines and thresholds to help us decide when to perform upfront surgery, when to postpone it, and when systemic treatment may offer greater value to the patient.
Endometriosis can be a debilitating, lifelong disease. We should therefore follow the most conservative treatment approach for as long as it remains effective.
Surgery is generally reserved for patients who have contraindications to pharmacotherapy, whose disease is refractory to treatment, or whose symptoms remain so severe that medication is not providing adequate relief. These account for the majority of surgical indications in our endometriosis practice.
Long waiting lists remain a major challenge for patients with endometriosis. What are you seeing in Poland, and how could access to care improve?
We are seeing a shift from long surgical waiting lists towards long diagnostic waiting lists. This is an increasingly important issue internationally.
In our experience, once patients receive an accurate diagnosis, an assessment of the extent of their disease, and appropriate treatment, many manage very well without surgery.
We now have long waiting lists for advanced diagnostic investigations, such as endometriosis oriented ultrasound protocol (IDEA) and MRI, rather than for surgery itself. There has been a significant shift in endometriosis patients’ management towards establishing a proper diagnosis and choosing appropriate treatment, rather than moving directly to surgery as the first intervention.
Where do you see opportunities to reduce the radicality of surgery in gynaecological cancer, and where does extensive surgery remain essential?
It depends on the cancer type. In cervical cancer, there is a tendency towards reducing the extent of surgery, while more advanced cases are more likely to be treated with chemoradiotherapy.
In endometrial cancer, the situation can be different: some patients require more extensive surgery, depending on the characteristics of their disease.
For ovarian cancer, optimal cytoreduction, ideally with complete removal of visible disease, remains a central part of treatment and an important determinant of survival. That remains the current standard.
Would you therefore expect the tendency for less radical surgery to be in ovarian cancer?
Ovarian cancer requires particularly comprehensive treatment because, in many cases, the disease has already spread throughout the abdominal cavity by the time it is diagnosed. Systemic treatment is therefore extremely important, but surgery continues to play a major role.
We have not yet seen a change in ovarian cancer treatment that would allow us to substantially reduce the radicality of surgery based on response to systemic therapy alone.
Having trained in gynaecological oncology at University College London Hospital, UK, and worked across European surgical settings, where do you still see important differences in care? Is greater standardisation needed?
In Europe, we have a very robust and effective professional society in the European Society of Gynaecological Oncology (ESGO). It has grown enormously over the past 25 years.
I joined in 2001 or 2002, and my membership number was 357. To see the society grow from a few hundred members to few thousands is really impressive.
ESGO has driven important clinical pathways and standardisation initiatives to help unify the treatment of patients with gynaecological cancer across Europe. From my perspective, treatment approaches are now quite consistent. I see differences between individual centres, but I do not think there are necessarily major differences between countries.
Guidelines, educational pathways, professional exchanges, and extensive training activities have all contributed to this. You can find different approaches within the UK itself, for example, but if you compare a major London centre with the University Hospital in Kraków, I would not expect to see substantial differences in the overall approach to treatment.
As surgical techniques become increasingly advanced, how should we train the next generation of gynaecological surgeons?
This is an excellent question. In the traditional model, there was a surgeon and an assistant. Trainees started with very basic tasks and gradually moved towards more advanced procedures, gaining experience over time.
With the increasing use of robotic surgery, that progression becomes more challenging. Robotic surgery can be something of a theatre with a single actor: once someone sits at the console, they immediately become the main surgeon.
Some centres have dual consoles, which offer opportunities for supervised training, but we do not have that facility in my hospital. This creates a real challenge.
I think simulators, AI tools, and training in anatomical navigation will be essential in preparing surgeons for that responsibility. We need ways to help people develop the necessary skills before they take on the main operating role, because the pathway is very different from traditional surgical training.
Reflecting on this year’s European Society for Gynaecological Endoscopy (ESGE) Congress, which developments or debates have the greatest potential to change practice over the next few years?
That would definitely be robotics and AI, though I think we are still somewhat apprehensive about engaging with these developments because it is difficult to imagine just how much they could change our everyday practice.
Over the next few years, these technologies will certainly be part of the discussion. The increasing autonomy of advanced devices is impressive and could be enormously helpful.
At the same time, it raises important questions. Where should the limits of machine autonomy lie? At what point is human input essential?
I think discussing those boundaries, and becoming more familiar with what these technologies can do, will be essential over the coming years.
