Obstet Gynecol Sci.  2021 Nov;64(6):560-564. 10.5468/ogs.21202.

Robotic assisted cytoreductive surgery, removal of a recurrent disease in the right pericaval lymph node in a patient with ovarian cancer with the robotic Xi platform

• Shoraka M
• Metwally H
• Carbajal-Mamani S
• Cardenas-Goicoechea J

• KMID: 2522482
• DOI: http://doi.org/10.5468/ogs.21202

Abstract

Objective
The standard approach for recurrent ovarian cancer is laparotomy. In this video, we present a cytoreductive surgery using the robotic Xi platform to remove a 2.7 cm pericaval tumor.
Methods
A narrative video demonstration of robotic-assisted surgery to remove recurrent ovarian cancer in a pericaval lymph node. A 62-year-old female presented with recurrent carcinoma of the pericaval lymph node. After 40 months of surveillance, the patient was asymptomatic, but a computed tomography (CT) scan showed an isolated mass (2.7×2.3 cm) in the right pericaval lymph node. Her cancer antigen (CA)-125 level increased from 26 to 46 U/mL. The robotic Xi platform was used to remove the metastatic lymph nodes. The first step was diagnostic laparoscopy. The second step was robotic port placement below the umbilicus. The third step was dissection and identification of landmarks, and the last step was removal of the tumor and closure.
Results
The metastatic lymph nodes were removed. The patient was discharged on postoperative day 1 and had no postoperative complications. Her CA-125 level dropped to 17 U/mL two weeks after surgery. Pathology showed metastatic high-grade serous carcinoma in one lymph node, consistent with the patient’s known primary. Two additional lymph nodes were removed and negative for carcinoma. Pelvic washings were negative for malignancy.
Conclusion
Robotic-assisted surgery is safe and feasible in selected patients with isolated recurrent disease.

Keyword

Ovarian neoplasm; Recurrence; Lymph nodes; Cytoreduction surgical procedures; Robotic surgical procedures

Figure

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  Fig. 1 Abdominal and pelvic computed tomography scan abdomen and pelvis showing pericaval lymph node (arrows). (A) Axial view. (B) Lateral view. (C) Coronal view.

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  Fig. 2 Surgical procedure. (A) Port placement. Accessory port at left upper quadrant. (B) Left lateral side docking with an abdominal approach. (C) Cephalad incision of peritoneum along the aorta. (D) Identification of landmarks, dissection of tumor, and isolation and sealing of the lymphatic channels and fellow veins. (E) End of procedure.

Reference

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