Use of a uterine manipulator appears to be associated with worse oncological outcomes in patients with uterus-confined endometrial cancer who undergo minimally invasive surgery, according to a study published in the American Journal of Obstetrics and Gynecology. Researchers performed a retrospective, multicentric study to assess the oncological safety of uterine manipulator use in patients with apparent earlystage endometrial cancer, treated with minimally invasive surgery, primarily seeking to determine relapse rates, but also recurrencefree and overall survival, as well as recurrence pattern. Among 2,661 women from 15 centers with similar histology, tumor grade, myometrial invasion, International Federation of Gynecology and Obstetrics (FIGO) stage, and adjuvant therapy, 1,756 underwent a hysterectomy with a uterine manipulator and 905 without. Recurrence rates were 11.69% in the uterine manipulator group and 7.4% in the no manipulator group, with manipulator use associated with a hazard ratio (HR) of 2.31 for recurrence. Uterine manipulator use in uterus-confined endometrial cancer (FIGO I-II) was associated with lower disease-free survival (HR, 1.74) and higher mortality risk (HR, 1.74). No differences were observed between the groups in recurrence pattern.