Introduction/Background Bulky tumors surrounding large pelvic vessels typically create vast collateral circulation and pose risk for direct injury. Such cases present significant surgical challenges, especially in elderly and medically compromised patients. Debulking technique via laparotomy is thought to be quicker in controlling catastrophic bleeding but may be less precise in dissection and isolation of large vessels and collaterals. Typically, minimally invasive approach (MIS) to difficult pelvic surgery is associated with lower blood loss (EBL). Rate of locoregional control with use of radiation corelates with size of residual tumor.

Methodology Surgical video. We demonstrate our technique for preparation for difficult dissections in cases at high-risk of large blood loss and vessels injuries. Robotic adaptation of vascular technique including unobscured exposure, identification of landmarks, identification and control of collateral blood supply, proximal and distal control of large vessels are discussed and demonstrated. Repair of 8 mm external iliac vein injury with utilization of vessel loops and 5–0 Prolene suture is demonstrated.

Results Resection of 8 cm recurrent endometrial cancer wrapping around iliac vessels with minimal blood loss.

Conclusion Robotic approach may facilitate precise dissection of pelvic vasculature. Control of blood supply to the dissection field and control of large vessels, before engaging in tumor debulking, may result in minimal blood loss. Large vessels injuries can be repaired quickly if prior proximal and distal control is assured. Robotic debulking surgeries require meticulous preparation, time and experienced staff. MIS approach may result in faster recovery and easier tolerance of adjuvant treatment.

Disclosure Nothing to disclose