Robotic Resection of Isolated Ovarian Cancer Recurrence in the Lesser Sac

Abstract

<h3>Study Objective</h3> Demonstrate the technique necessary for safe minimally invasive surgery in the lesser sac for removal of recurrent ovarian cancer. <h3>Design</h3> A step-by-step video review of the pertinent anatomy and surgical technique for robotic secondary cytoreduction in the lesser sac. <h3>Setting</h3> Robotic surgical platform, reverse Trendelenburg position. <h3>Patients or Participants</h3> 78-year-old BRCA negative female with a history of stage IIIC high-grade serous ovarian cancer presenting with a 24-month disease free interval and a 2.2 cm recurrent ovarian cancer lesion in the lesser sac, near the neck of the pancreas <h3>Interventions</h3> The patient received 3.75mg of indocyanine green prior to the procedure to assist with identification of the common bile duct. She was placed in the supine position with 20 degrees of reverse Trendelenburg. A 30 degree downward facing endoscope was used. <h3>Measurements and Main Results</h3> In this video, we discuss important pre-procedural/anatomic considerations for robotic resection of recurrent ovarian cancer in the lesser sac. Port placement was performed using standard robotic port locations for upper abdominal surgery. An incision was made along the lesser omentum and the mass was identified within the lesser sac. The common bile duct was identified with the use of a near infrared filter. The lesion was dissected away from the pancreas. After the common hepatic artery was identified at the base of the resection, the remaining attachments were removed. Operative time was 60 minutes and without complications. She was discharged home on the day of surgery and had an uncomplicated postoperative course. <h3>Conclusion</h3> Minimally invasive surgery in the lesser sac is feasible and safe in well-selected patients with recurrent ovarian cancer. Positioning and familiarity with pertinent anatomy are critical for successful surgery in this region.