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Transumbilical laparoendoscopic single site surgery has significant advantages in terms of minor incision, specimen retrieval, slight pain, and rapid recovery. The feasibility and safety of performing ovarian cancer staging surgeries through a single site approach has been proved.1 However, the risk of intraoperative complications during transperitoneal lymphadenectomy, including vascular, intestinal, and ureteral injuries, is increasing due to the lack of assistance, especially for obese patients. Previous studies reported the lateral extraperitoneal approach to achieve better exposure and dissection of the para-aortic lymph nodes with a lower risk of complications, while bilateral obturator regions were poorly explored due to limitations of views and instrumental degrees.2
Thus we designed an innovative extraperitoneal approach through the same umbilical incision which achieves satisfactory visualization and lymph node retrieval of both pelvic and para-aortic areas.3 4 Also, we found that the approach was particularly suitable for fertility sparing because it can maintain an intact peritoneum and reduce intraperitoneal adhesion, which might contribute to a future pregnancy. It also enables easier specimen extraction from the umbilical incision in fertility sparing surgery without hysterectomy compared with multi-port laparoscopy.
Here we demonstrate the procedure steps and advantages of the transumbilical laparoendoscopic single site extraperitoneal approach in fertility sparing staging surgery of epithelial ovarian cancer, with a surgical video and a summary of the case series. The whole surgical procedure was completed through a 2 cm umbilical incision. A purse string suture and incision of the posterior peritoneal incision above the aortic bifurcation were completed under laparoscopy. An appropriative port was inserted into the extraperitoneal space to perform lymphadenectomy. Other concomitant procedures were completed intraperitoneally.
To date, four patients diagnosed with stage I epithelial ovarian cancer with fertility sparing demands were treated with this surgical technique. Mean operative time was 225 min. Mean blood loss was 107.5 mL and no transfusion was required. No intraoperative complications or conversions occurred. Mean postoperative hospital stay was 3.0 days. Final pathology examination revealed a median count of 25.3 for retrieved pelvic lymph nodes and 14.3 for para-aortic nodes. Two patients subsequently became pregnant. The transumbilical laparoendoscopic single site extraperitoneal approach is of great advantage in fertility sparing staging surgery of epithelial ovarian cancer, with promising reproductive outcomes.
Establishment of the extraperitoneal approach.
Accomplishment of lymphadenectomy.
Data availability statement
All data relevant to the study are included in the article.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by West China Second University Hospital (protocol identification No: 2020150). Participants gave informed consent to participate in the study before taking part.
Footnotes
Contributors YC was responsible for video production, data collection, data interpretation, and manuscript preparation. YZ was responsible for the concept and design of the study, manuscript modification and the overall content as the guarantor. SC and SP performed the surgeries.
Funding This work was supported by Key Science and Technology Projects of Sichuan Province (2021YJ0137).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.