Single-Site Robot-Assisted Laparoscopic Staging Surgery for Presumed Clinically Early-Stage Ovarian Cancer

Abstract

Study objective: To present the demonstration of robotic-assisted laparoendoscopic single-site (R-LESS) staging surgery in presumed clinically early-stage ovarian cancer.

Design: A step-by-step presentation of the procedure using video (Canadian Task Force classification III).

Setting: A university hospital.

Patient: A 29-year-old woman was referred from a local clinic for an 8 × 6 cm left ovarian tumor suggesting malignancy. Her serum cancer antigen 125 level was 1636 U/mL. There was no evidence of a metastatic tumor or lymph node enlargement on magnetic resonance imaging or positron emission tomographic/computed tomographic imaging.

Intervention: Under general anesthesia, a 2-cm vertical intraumbilical incision was made, and a Lap Single trocar (Sejong Medical, Ltd, Gyeonggi-do, South Korea) was applied. The entire abdominal cavity was clear without any seeding tumor or adhesion. We performed laparoendoscopic single-site left salpingo-oophorectomy. On frozen section, high-grade epithelial malignancy was diagnosed. We started R-LESS staging surgery with the Da Vinci Xi system (Intuitive Surgical, Inc, Sunnyvale, CA). Fenestrated bipolar forceps and a permanent cautery hook were introduced. Both pelvic and inferior mesenteric para-aortic lymphadenectomy was performed. The patient was tilted in a reverse Trendelenburg position while performing infracolic omentectomy.

Main results: The total operation took 280 minutes, and the console time was 135 minutes. The estimated blood loss was 100 mL. The patient was discharged on the next day after surgery. Histopathologic evaluation revealed a poorly differentiated endometrioid carcinoma. A total of 15 pelvic lymph nodes and 7 para-aortic lymph nodes were retrived. Among them, 2 para-aortic lymph nodes showed malignancy.

Conclusion: We could successfully perform R-LESS staging surgery for presumed clinically early-stage ovarian cancer without any complications.

Keywords: Ovarian cancer; Para-aortic lymphadenectomy; Robotic; Single site.