Robotic Interval Cytoreductive Surgery for Stage IV Epithelial Ovarian Cancer

Abstract

Video Objective To demonstrate a surgical video where-in interval cytoreduction to no gross residual disease was performed robotically in a patient with Stage IV epithelial ovarian cancer. Setting Tertiary referral center. Interventions 43-year-old Caucasian female was diagnosed with stage IV-A high-grade serous ovarian adenocarcinoma after presenting with shortness of breath. Computed tomography showed bilateral pleural effusions, adnexal masses, retroperitoneal lymphadenopathy, omental caking. Thoracentesis confirmed adenocarcinoma of Mullerian primary. She received three cycles of neoadjuvant carboplatinum and paclitaxel with excellent clinical response and was taken to the operating room for robotic-assisted interval cytoreductive surgery. Trocars were placed on a straight horizontal line along the umbilical fold. The rectosigmoid colon was mobilized medially. Pararectal and paravesical spaces were developed. Ureterolysis was completed bilaterally. The uterine vessels were sealed at the hypogastric bifurcation. Infundibulopelvic (IP) ligament was sealed and cut. Bilateral pelvic sidewall peritoneum was resected. Bladder flap was developed. Colpotomy was performed and the hysterectomy specimen was removed. Procedure was then continued with debulking of enlarged lymph nodes, from bilateral pelvic sidewalls and peri-aortic area. The robotic arms were targeted to the upper abdomen for total omentectomy. Access to the lesser sac was gained by resecting short gastic vessels, along the greater curvature of the stomach. The incision was then extended to the splenic flexure and hepatic flexure. Total omentectomy was completed. Remaining subcentimeter tumoral nodules along the peritoneal surfaces were ablated with argon beam coagulator. The patient had an uneventful postoperative course and was discharged home on postoperative day 1. Pathology confirmed high grade serous ovarian carcinoma. She was resumed on chemotherapy two weeks after her cytoreductive surgery. Conclusion Laparoscopic/robotic interval cytoreductive surgery should be considered in advanced ovarian cancer patients, who have an excellent clinical response to NACT. Studies to accurately identify the appropriate patient population for laparoscopic/robotic debulking procedures are urgently encouraged and needed.