During the last few decades, radical hysterectomy (RH) for early-stage cervical cancer has been performed either by laparotomy or a minimally invasive (MIS) approach, which were both considered acceptable and safe. However, the results of the phase III multicentric randomized LACC trial showed that MIS radical hysterectomy was associated with worse disease-free survival and overall survival.

A recently published Swedish nationwide population-based cohort study showed that the recurrence pattern was similar after open and robotic RH for women with early-stage cervical cancer. Based on these results, the authors designed the Robot-assisted Approach to Cervical Cancer (RACC) study, a randomized non-inferiority trial of robot-assisted laparoscopic surgery versus laparotomy. A European observational study comparing MIS versus open surgery showed that MIS increased the risk of relapse and death compared with open surgery. However, by avoiding use of the uterine manipulator and utilizing maneuvers to prevent tumor spread at the time of colpotomy, MIS was associated with similar outcomes to open surgery.