Robotic Tumor Debulking off External Iliac Vessels for the Management of Recurrent Ovarian Cancer

ObjectiveTo show a surgical video in which an isolated mass was resected off the external iliac vessels for the management of recurrent ovarian cancer.DesignCase report.SettingTertiary referral center in New Haven, Connecticut.InterventionsThis is a step-by-step demonstration of a robotic tumor debulking in a patient with isolated recurrence of epithelial ovarian cancer [1Escobar PF Levinson KL Magrina J et al.Feasibility and perioperative outcomes of robotic-assisted surgery in the management of recurrent ovarian cancer: a multi-institutional study.Gynecol Oncol. 2014; 134: 253-256Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 2Magrina JF Zanagnolo V Noble BN Kho RM Magtibay P Robotic approach for ovarian cancer: perioperative and survival results and comparison with laparoscopy and laparotomy.Gynecol Oncol. 2011; 121: 100-105Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar, 3Gallotta V Conte C Giudice MT et al.Secondary laparoscopic cytoreduction in recurrent ovarian cancer: a large, single-institution experience.J Minim Invasive Gynecol. 2018; 25: 644-650Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar]. The patient is a 70-year-old woman with Lynch syndrome who received a diagnosis for stage IIC high-grade serous ovarian adenocarcinoma and underwent complete debulking in 1996. She had most recently been on pembrolizumab for microsatellite instability-high tumor until February 2019, when she received a diagnosis for isolated hypermetabolic mass in close proximity to the external iliac vessels and right iliac fossa.The patient was placed in dorsal low lithotomy Trendelenburg position, and 15° leftward tilt of the table was obtained to expose the right pelvic sidewall and iliac fossa. To optimally target the surgical field of interest, all robotic trocars were placed in a straight line starting from 5 cm above symphysis pubis on the left side to left subcostal line between the midline vertical and the left midclavicular lines, as per the manufacturer's port placement guidelines (Fig. 1).ConclusionRobotic resection of the tumor nodule off the external iliac vessels was successfully performed with adequate range of motion provided by the arms and without any complications. Trocar placement should be tailored to the site of surgical interest. Robotic-assisted laparoscopy should be considered as a valid alternative to the traditional open approach, when managing solitary masses in patients with recurrent ovarian cancer.