Robotic Tumor Debulking Off External Iliac Vessels For Management of Recurrent Ovarian Cancer

ABSTRACT Objective To demonstrate a surgical video wherein an isolated mass was resected off the external iliac vessels for management of recurrent ovarian cancer. Design Case report. Setting Tertiary referral center in New Haven, CT. Interventions This is a step-by-step demonstration of a robotic tumor debulking in a patient with isolated recurrence of epithelial ovarian cancer ( 1 , 2 , 3 ). Patient is a 70 year old with Lynch Syndrome who was diagnosed with Stage IIC high grade serous ovarian adenocarcinoma and underwent complete debulking in 1996. She had most recently been on pembrolizumab for microsatellite instability(MSI)-high tumor until Februay 2019, when she was diagnosed with in isolated hypermetabolic mass in close promixity to the external iliac vessels and right iliac fossa. 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 ( Figure 1 ) . Conclusions Robotic 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 recurrent ovarian cancer patients.