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486 Techniques of quadrant wise cytoreductive surgery in advanced epithelial ovarian cancer: total parietal peritonectomy + retrograde hysterectomy + mesentric stripping & glissons capsulectomy
  1. SP Somashekhar,
  2. C Rohit Kumar and
  3. KR Ashwin
  1. Manipal Hospital, India


Objective Cytoreductive surgery is the cornerstone of therapy for advanced epithelial ovarian cancer. Optimal cytoreduction defined as removal of all visible macroscopic disease has shown to improve disease free & overall survival in several studies. Addressing the disease in the upper abdomen in ovarian cancer is of at most significance for optimal cytoreduction apart from lower abdomen disease. Surgery in the upper abdomen is very challenging and needs sound knowledge of surgical anatomy, standard practice of surgical techniques overtime for better outcomes.

Methods This video shows various techniques of cytoreductive surgery done quadrant wise with description of regional applied surgical anatomy and voice over by a experienced gynec-oncosurgeon over a period of 15 years.

Right upper quadrentectomy shows techniques of glissons capsulectomy, ponta hepaticus dissection, diaphragm stripping and resection, lesser omentetctomy & bursectomy.

Left upper quadrentectomy shows techniques of diaphragm resection, splenectomy and tail of pancreas resection, total supra-colic omentectomy & omental bursectomy.

Lower abdominal surgery shows techniques of retrograde hysterectomy with pouch of douglasectomy and pelvic peritonectomy, bowel resection and anastomosis.

Video also shows techniques of total parietal peritonectomy, mesenteric stripping & management of nodules on bowel surface.

This video also shows how to use different surgical gadgets and energy sources for optimizing the available resources to achieve optimal cytoreduction- use of CUSA, harmonics, monopolar cautery with sharp and round tip blades using high cautery setting, also single swab and double swab technique for peritonectomy.

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