Laparoscopic Repair for Full Thickness Resection of Diaphragm Metastases in Ovarian Cancer

Abstract

Study Objective To describe the laparoscopic surgical technique to safely repair a full thickness diaphragm ovarian cancer resection, as well as the intraoperative trans-diaphragmatic pneumothorax decompression and lung re-expansion technique. Additionally, the role of minimally invasive surgery to resect diaphragm metastases in ovarian cancer will be discussed. Design Surgical educational video. Setting Tertiary care center at an academic institution. Operating room procedure with patient on lithotomy with reverse Trendelenburg position and a leftward tilt. Patients or Participants Case description of a 39-year-old patient with stage IIIB high grade serous carcinoma of the ovary who presented for interval debulking surgery. Interventions Laparoscopic cytoreduction with resection of diaphragmatic metastases. This video emphasizes the most important surgical steps to safely perform a minimally invasive full thickness right hemi-diaphragmatic defect repair after resection of full thickness ovarian cancer metastases. A trans-diaphragmatic lung re-expansion technique using a suction catheter with purse string suture and Valsalva is shown. Measurements and Main Results N/A Conclusion Laparoscopic resection of diaphragm metastases with intraoperative trans-diaphragmatic pneumothorax decompression is feasible and safe in selected patients. Surgical expertise with adequate laparoscopic needle handling is necessary for a safe repair.