Malignant cells, due to decreased cohesion between them, are more likely to exfoliate and implant at distant sites during manipulation. This concern was first expressed by A.G. Gerster in 1885. In this review, we undertook a comprehensive search of the literature to find the evidence for or against the iatrogenic implantation of cancer cells. An exhaustive search on PubMed, Medline, Embase, Science Direct, and Google Scholar yielded 215 relevant publications. The evidence presented in these publications was extracted and synthesized to draw conclusions for this review. Diagnostic and therapeutic procedures through fine/wide bore needles have demonstrated malignant cells in the needle tract but the incidence of recurrences ranges from 0.0003% to 0.9%. There is evidence of malignant cells adhering to surgical instruments, and some reports showed that the number cells needed for successful implantation is 106 – 107 cells in porcine models. A recent prospective study on colorectal malignancies has shown that the presence of intraperitoneal cells reduced 2-year survival but was not an independent predictor of the outcome. Port site recurrences have been documented since 1978 but the current consensus is more inclined to supporting the improper manipulation of tumor, rather than the laparoscopic procedure itself, as the inducer of port site recurrences. Intraperitoneal morcellation of leiomyomas and leiomyosarcomas does cause intra-peritoneal dissemination of tumor cells. Finally, many approaches to preventing implantation have been explored but lavage of operative site with distilled water may stand as the most promising strategy.

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