Introduction/Background Retrospective evidences claiming both surgical and oncological adequacy of the minimally invasive (MIS) approach at the time of interval debulking surgery, led to the design of an ongoing prospective randomized controlled trial (LANCE trial) with the primary aim to investigate whether MIS is non-inferior to laparotomy in terms of disease free survival. In selected patients with a good clinical, biochemical and radiological response to neoadjuvant chemotherapy (NACT), the laparoscopic approach could be potentially beneficial in terms of perioperative and cosmetic outcomes.

Methodology We present the case of a 46 years old woman diagnosed with a FIGO stage IIIC high grade serous ovarian carcinoma who underwent IV cycles of NACT with a partial response according to RECIST criteria, negative Ca125 and a ‘favourable’ KELIM score (1.01). The patient was BRCA1mut and HRD positive

Results The IDS was successfully completed with a complete gross resection after the full exposure of all abdominal quadrants. The surgical complexity was high due to residual disease after chemotherapy, requiring a complete diaphragmatic stripping, a vascular-sparing radical omentectomy and a mesorectal-sparing posterior pelvic exenteration with a totally intracorporeal colorectal anastomosis. Surgery lasted 4 hours and 24 minutes with an estimated blood loss of 300cc. No intraoperative or postoperative complications occurred and the patient was discharged on postoperative day four. The chemotherapy response score was 2 and the time to chemotherapy 31 days.

Conclusion The oncological adequacy of MIS is currently under investigation although supported by retrospective data. Technological advancement and technical refinement are progressively narrowing the distance between MIS and open surgery, expanding the portfolio of possible minimally invasive surgical procedures and potentially the indications for laparoscopic IDS.