Robotic Lymph Node Resection Off the Aortic Bifurcation for Presumed Recurrence Management of Advanced Ovarian Cancer

Study Objective To demonstrate a surgical video where-in lymph node resection was performed robotically in a patient with presumed ovarian cancer recurrence. Design Case report and a step-by-step video demonstration of robotic lymph node resection off of the aortic bifurcation (Canadian Task Force classification III). Setting Tertiary referral center. Patients or Participants 42-year-old female with stage IIIA1 high-grade serous ovarian adenocarcinoma. Interventions 42-year-old female was diagnosed with stage IIIA1 high-grade serous ovarian adenocarcinoma in 2018 when she underwent upfront optimal cytoreductive surgery, inclusive of extensive debulking of aortocaval lymphadenopathy. The patient remained disease free until February 2020, when surveillance imaging showed a single hypermetabolic lymph node, anterior to the left common iliac artery. She was taken to the operating room for robotic debulking. Robotic trocars were placed on a horizontal line along the umbilical fold. Exploration of the peritoneal cavity revealed no evidence of disease. There was some adhesive disease over right pelvic sidewall and distal small bowel mesentery was overlying the aortic bifurcation. These adhesions were taken down by paying meticulous attention in order not to injure the small bowel mesentery. The retroperitoneum was explored to the level of the third part of the duodenum. Aortocaval lymph node basins were explored. The IMA was skeletonized and left ureterolysis was performed; allowing safe access to the left para-aortic as well as to the presacral area. The suspicious lymph nodes, including the one which correlated with the hypermetabolic left common iliac lymph node were resected without any complications. Measurements and Main Results Successful robotic secondary debulking was performed. The patient was discharged home on postoperative day 0. Pathology of the suspicious lymph nodes were negative for malignancy. Therefore, the patient was deemed free of disease and has been scheduled for surveillance imaging in three months. Conclusion Robotic secondary debulking of presumed ovarian cancer recurrence is feasible and should be considered in selected patients.