Introduction/Background*We developed a new mini-invasive access to perform an endoscopic extra-peritoneal para-aortic lymphadenectomy via a single-port umbilical device. This technique allows, per se, access to the peritoneal space, so complementary staging procedures can be performed via the same single-port. Here we describe the use of the technique to stage an early ovarian cancer patient, including a pelvic and para-aortic lymphadenectomy up to the left renal vein. So far in gynaecologic surgery, two distinct types of endoscopic accesses have been used to perform paraaortic lymphadenectomies: trans-peritoneal and extra-peritoneal, each with advantages and disadvantages. We previously reported the use of our technique to stage locally advanced cervical cancer patients prior to concomitant radio-chemotherapy, combining the advantages of those two approaches while eliminating their disadvantages. Here we report the use of this technique to perform a complete staging for an ovarian cancer patient.

Methodology This innovative approach combines both an extra-peritoneal and an intra-peritoneal procedure via the same umbilical incision using one single trocar (Applied Medical Gelpoint Mini°) The key point is to grab the peritoneum overlying the aorta bifurcation, raise it to the umbilicus and re-introduce the single-port device into the retroperitoneal space. All the paraaortic lymphatic basins are dissected up to the left renal vein. Once the para-aortic lymphadenectomy is done, the trocar is reinserted into the peritoneal space, always through the same incision, to perform the endoscopic lymphadenectomy and bilateral pelvic lymphadenectomy, along with the hysterectomy. The procedure was undertaken for a 66 years old patient, with a supposed FIGO IC2 ovarian tumour previously diagnosed after a trans-umbilical single-port endoscopic bilateral adnexectomy.

Result(s)*The intervention has been successful in this patient with FIGO stage IC2 ovarian cancer with a duration of 5 hours. Recent history of bilateral adnexectomy did not cause gas leakage from the retroperitoneal space. 48 lymph nodes were retrieved, all free from disease. No complications occurred.

Conclusion*We describe here a promising technique that combines all the advantages of the two previously described retroperitoneal accesses without their disadvantages. It can also be extended to any other type of retroperitoneal surgery.