Introduction/Background We have developed a systematic surgical approach of a bat-shaped en-bloc total peritonectomy- total hysterectomy-salpingo-oophorectomy with or without rectosigmoid resection. In this video presentation we aimed to demonstrate the technique.

Methodology Methodology: Fifteen steps were identified in the Sarta-bat surgical approach. 1. Diagnostic-explorative laparoscopy 2. Median incision from xiphoid to pubis 3. Exploration and ascites drainage 4. Retroperitoneal carbon dioxide insufflation 5. Dissection of both costal arch peritoneum and placement of the automatic retractors 6. Incision of the superior part of falciform ligament 7. Demarcation of the diaphragmatic peritoneum from the hepatic veins 8. Complete liver mobilization 9. Dissection of the peritoneum of right diaphragm, Morisson, right abdominal wall and gutter 10. Stripping of the left diaphragm, abdominal wall and gutter peritoneum 11. Ligation and cutting of the IP ligaments after designation and segregation of the ureters 12. Pelvic and bladder peritoneum dissection and transection of the round ligaments 13. Bladder and ureter mobilization 14. Total hysterectomy-salpingo-oophorectomy with retrograde Douglas and visceral peritonectomy ± rectosigmoid resection 15. Suturing of the vaginal cuff ± colorectal anastomosis. The technique with detailed steps will be demonstrated as video presentation.

Results Sarta-Bat approach was performed as en-bloc total peritonectomy, total hysterectomy bilateral salpingo-oophorectomy with or without rectosigmoid resection. Final surgery resulted in high rate of complete cytoreduction (no macroscopic residual) with acceptable morbidity rates.

Conclusion Sarta-Bat approach is a feasible and convenient technique for cytoreductive surgery of advanced ovarian cancer with disseminated peritoneal metastases.