Introduction Mesonephric-like adenocarcinoma (MLA) of the uterine corpus is a rare and distinct gynecological malignancy. MLA has a similar appearance to mesonephric adenocarcinoma of the uterine cervix or vagina, which originates from mesonephric remnants. Despite presenting with symptoms and signs similar to more common types of endometrial carcinoma, MLA tends to behave more aggressively, with advanced-stage disease at diagnosis, rapid progression, frequent recurrence, distant metastases, and poor prognosis.

Description This video showcases a case of robotic-assisted tumor debulking in a 60-year-old patient with metastatic mesonephric-like uterine carcinoma. The patient had a past medical history of fibroid uterus and endometriosis and presented with pelvic pain and postmenopausal bleeding. Imaging showed a dominant intramural uterine fibroid that had significantly increased in size, right pelvic sidewall and external iliac lymphadenopathy, and associated peritoneal thickening. CT imaging showed intense hypermetabolic activity in the uterus consistent with malignancy and hypermetabolic pelvic lymph nodes. At the time of the procedure, the patient was found to have extensive peritoneal carcinomatosis, bulky lymph nodes, and a tumor on the ureter, with distorted anatomy due to a large multi-fibroid uterus and dense adhesive disease on the vesico-uterine space. This video aims to review the surgical techniques used in complex minimally invasive debulking procedures. By the end of the procedure, all visible cancer was removed. The procedure was uncomplicated, and the patient was discharged on postoperative day 0.

Conclusion/Implications Our video provides valuable insights into the surgical techniques used to achieve complete tumor resection in complex cases with aggressive uterine tumors.