Introduction

A complete cytoreductive surgery significantly impacts prognosis for ovarian cancer patients. Diaphragmatic peritoneal stripping is a key step to achieving complete macroscopic resection in the upper abdomen. To describe this technique, the literature is scarce and the training centers are limited.

Description

In this video, our patients were placed in a low lithotomy position, with a xifo-pubic incision, under general anesthesia. All patients received pre-operative physiotherapy and nutritional support. The liver lobes were mobilized (described in another video*), and the margin between normal and involved peritoneal surface was marked with monopolar energy. It is important to identify the avascular plane between the diaphragmatic muscle and the affected peritoneum. Entering the muscle is indicated only if there is muscle infiltration by macroscopic tumor. Allis or Collin clamps supported manual traction to the borders of the peritoneum, while the liver is retracted medially. A small rounded surgical sponge may be used to push the muscle off the peritoneal surface (blunt dissection), reducing the need for monopolar energy.

When the Morison pouch is involved, the same principles may be applied.

For the left diaphragmatic stripping, the left lobe is mobilized, and the infiltrated peritoneum is similarly removed.

Conclusion/Implications

This video demonstrates some useful tips to achieve a complete cytoreductive procedure that includes hepatorenal pouch, and right and left diaphragmatic peritoneal stripping.

Introduction

To investigate the feasibility of laparoscopic secondary cytoreduction in patients with recurrent ovarian cancer with previous laparoscopic primary debulking surgery

Description

Patients: A 52-year-old Korean woman underwent laparoscopic secondary cytoreduction for recurrent ovarian cancer and previous laparoscopic primary debulking surgery

Interventions: Laparoscopy Measurements/Results: A 52-year-old Korean woman had a laparoscopic primary optimal debulking surgery. The FIGO stage IIIC was confirmed and she received 12 cycles of paclitaxel/carboplatin chemotherapy. Since then, it had been checked as NED state for 6 months. During follow up, lab results showed elevation of CA125, and recurrence was confirmed by PET-CT imaging. We performed LAVH with BSO, CDS mass excision, pelvic and para-lymphadenectomy during primary debulking surgery. In addition, diaphragm and omentectomy were performed. She received adjuvant chemotherapy with paclitaxel/carboplatin for 12 cycles. We performed the laparoscopic secondary cytoreductive surgery on November 28, 2017. Peritoneal cavity and diaphragm were clear and showed no metastatic nodule. Metastatic lymph nodes were confirmed along the left iliac vessels like seen in the previous PET-CT imaging and we resected them. What was seen as recurrence around right para-colic gutter area were metastatic nodule on the cecum surface. We removed the nodules and repaired the bowel serosa. She is receiving chemotherapy with stable disease at this time.

Conclusion/Implications

Our experience indicate that laparoscopy is a feasible and safe approach to optimal cytoreduction for patients with recurrent ovarian cancer in case of laparoscopic primary debulking surgery.

Introduction

Ovarian cancer is the most lethal gynecologic malignancy and in 75% of cases are diagnosed in advanced stages unfortunately 30% of patients with advanced ovarian cancer present pleural effusion at the time of initial diagnosis, that has been associated with worse disease-free survival and overall survival.

Description

A 48-year-old women who present a 3-month history of bloating and abdominal pain. Tomography of the abdomen and chest showing left pleural effusion with bilateral adnexal masses, peritoneal carcinomatosis and a ca 125 of 1753. The patient was given 4 chemotherapy cycles with partial imaging and serological response. Control images showed persistence of pleural effusion in the left hemithorax that was previously compromised by adenocarcinoma, so it was decided to perform left thoracoscopy to define secondary pleural involment. The main finding during thoracoscopy is evidence of a 5 cm lesion at the level of the left diaphragmatic peritoneum with full full thickness infiltration with no other lesiones in pleura cavity. The patient was taken to a complete abdominal cytoreduction by laparotomy with an adequate clinical evolution pending the restart of chemotherapy.

Conclusion/Implications

It is important to mention that metastatic involvement of pleural effusion has a high correlation with pleural involvement. The main prognostic factor for overall survival in ovarian cancer is complete cytoreduction, thats why we must establish the areas affected by this neoplasm and define the possibility of undergoing surgery. Video asisted thoracoscopy is a low-morbidity procedure that allows us to evaluate pleural and mediastinal involvement in patients with pleural effusion.

Introduction

To present laparoscopic restasing surgery for ovarian cancer mimicking a parasitic myoma discovered during LAVH for huge uterine adenomyosis after HIFU.

Description

A 49-year-old Korean woman with severe dysmenorrhea and abnormal uterine bleeding to our department. She had received High intensity focused ultrasound (HIFU) for adenomyosis six years ago. Pelvic MRI showed typical adenomyosis feature with huge uterus with ill-defined myometrial lesion. We planned to perform laparoscopically assisted vaginal hysterectomy on September 13 2021. We discovered small mass mimicking parasite myoma on right paracolic gutter. After hysterectomy, we removed the myoma like mass and the mass was sent frozen section histological analysis revealed a diagnosis of serous carcinoma. We performed abdominal exploration and washing cytology. Additionally, we discovered small tumor nodules on both ovarian surface covered by huge adenomyoma. We finished the initial surgery to do baseline study for ovarian cancer. We performed the laparoscopic restaging surgery for ovarian cancer after baseline study on September 30, 2021. The FIGO stage IIIC was confirmed based on the final histopathological result.

Conclusion/Implications

Laparscopic restaging surgery for ovarian cancer mimicking a parasitic myoma discovered during LAVH for huge uterine adenomyosis after HIFU was safe and successful.

Introduction

Exploratory laparoscopy is an essential step for surgical staging in advanced ovarian cancer

With two objectives :

-to determine the best therapeutic strategy by evaluating the possibility of primary debulking surgery

-to perform biopsies to confirm the diagnosis and to allow molecular analysis

We propose a step by step video about laparoscopic staging in advanced ovarian cancer.

Description

We present a step-by-step laparoscopic exploration of the abdominal cavity for staging in advanced ovarian cancer, using Peritoneal Carcinomatosis Index, areas by areas. We want to show what are the pitfalls and blocking points for a primary debulking surgery.

Conclusion/Implications

We wish to show how to perform a rigorous exploration of the abdomen and how to make efficient and safe biopsies for a better management of the patients in advanced ovarian cancer.

Introduction

Optimal Cytoreduction CCO is the only sure Prognostic marker of good DFS and OS thats avaialble with Gynecological oncologist in advanced Ovarian cancer. But its not what we do in Pelvis alone that matters, but what we do and how we handle upper abdomen and diagpragm and Pontis hepatis and upper abdomen disease that translates to good OS. This video shows systematiclaly the surgical technqiue of Peritonecotmy and upper abdomen Optimal CRS quadrant wise to achieve Optimal CRS with HIPEC

Description

Optimal Cytoreduction CCO is the only sure Prognostic marker of good DFS and OS thats avaialble with Gynecological oncologist in advanced Ovarian cancer. But its not what we do in Pelvis alone that matters, but what we do and how we handle upper abdomen and diagpragm and Pontis hepatis and upper abdomen disease that translates to good OS. This video shows systematiclaly the surgical technqiue of Peritonecotmy and upper abdomen Optimal CRS quadrant wise to achieve Optimal CRS. the Glisson capusulectomy with Diaphragem resection and Mesentric stripping and managing Pontis Hepaticus and Pouch of Douglosectomy and retro grade hystrecotmy. and then HIPEC

Conclusion/Implications

We have done over 500 advanced ultra radiical surgery with HIEPC and 1100 ultra radical upper abdominal CRS without HIEPC and morbidity and and mortlaity is standardisesd aftet learning curve of 70 cases with these technqiue of Ball Point caurgery with 90 setting spray mode and systematic quadrant wise approach to high PCI ca ovarian cases.

this video shares this technqiue in this