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504 Tips and techniques to optimize access to difficult areas in cytoreductive surgery of the upper abdomen
  1. Lana Bijelic,
  2. Julian Henao,
  3. Domenico Sabia,
  4. Jaume Tur and
  5. Marina Bosch
  1. CHU Moises Broggi, Barcelona, Spain


Introduction/Background Cytoreductive surgery (CRS) of peritoneal metastases has the aim of complete resection of macroscopic disease and is a key component of treatment of ovarian cancer and other malignancies that frequently involve the peritoneum.

Complete resection of peritoneal metastases in the upper abdomen can be challenging due to complex anatomy and frequent involvement of difficult to access peritoneal recesses.

Methodology We created a 5-minute video to review technical steps and exposure tips that can be useful in order to achieve a complete cytoreduction of difficult to reach upper abdominal areas such as the epiphrenic space, the retrohepatic space, the area behind the portal triad and the superior recess of the bursa omentalis (retrocaudate space).

Results Five manuveurs and exposures to improve complete cytoreduction of the upper abdomen are presented: xyphoidectomy, extraperitoneal mobilization of the liver during right diaphragm peritonectomy, division of the ‘hepatic bridge, isolation and superior traction of the porta hepatis triad and rotation of the left lateral liver segment.

Conclusion Technical expertise in advanced cytoreductive techniques is necesary to achieve complete macroscopic resection of peritoneal metastases in difficult to reach areas in the upper abdomen.

Disclosures Not disclosure.

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