Introduction/Background*Paraaortic lymph node dissection is a challenging surgical procedure. Recent data mentioned that bulky nodal disease in ovarian/fallopian tube cancer patients stage IIB and above should be dissected in fallopian tube cancer patients that optimal primary cytoreduction has been achieved.

Methodology A challenging paraaortic lymph node dissection of a nodal block arising from fallopian tube cancer in a 76 years old patient is presented in this surgical video. Patient has been diagnosed with ovarian/fallopian tube cancer. Her CA 125 was 2161 IU/ml and her preoperative imaging has revealed a mass of right adnexa 7 x 3 cm, a metastatic abdominal mass involving the transverse colon and paraaortic lymph node 6 cm in dimension.

Result(s)*Abdominal hysterectomy, omentectomy, resection of the transverse colon, peritonectomies and dissection of the paraaortic nodal mass took place. No macroscopic residual disease was observed at the end of the procedure.

Conclusion*Removal of bulky nodal disease is indicated for patients with advanced ovarian/fallopian tube cancer. As applies in any paraaortic/retroperitoneal lymph node dissection resection of bulky lymph nodes can lead in intra or postoperative complications. Therefore, awareness of anatomical landmarks and anatomic variation are of paramount importance.