Introduction/Background This video shows a laparoscopic en-bloc resection of the pelvis with rectosigmoid resection and termino-terminal anastomosis in a 75-year-old patient affected by advanced ovarian carcinoma. The patient was discussed at our tumor board with a CT scan showing a solid pelvic mass (approximately 12x8x8 cm) upper abdominal and diaphragmatic disease. The findings were later confirmed at exploratory laparoscopy when a decision was made to perform up-front surgery.

The patient was recruited to the ULTRA-LAP trial (NCT05862740) and underwent up-front laparoscopic debulking.

Methodology The procedure begins with the exposure of the retroperitoneum. Subsequently, the pararectal, paravesical, and presacral spaces are developed. The uterine artery and infundibulo-pelvic ligament are identified and ligated bilaterally. The mesentery is opened and the proximal sigmoid-rectum colon is sectioned using a 60 mm Endo-GIA™ stapler. The presacral space is developed until a level caudal to the tumor. Peritonectomy of the bladder is completed and the vesicovaginal space is reached and anterior colpotomy is performed. Recto-vaginal septum is developed, meso rectum is sealed and sectioned, the distal end of the rectum is transected with an Endo-GIA™ again. The pelvic organs are removed through the vagina inside an endo-bag without the need for a service mini-laparotomy. Also through the vagina the proximal part of the colon is exposed to insert the anvil and suture over a purse string suture. The procedure concludes with the creation of a trans-anal termino-terminal anastomosis using an ECHELON™ circular stapler.

Results No protective ileostomy was performed. Bowel opening occurred on the fifth postoperative day, and the patient was discharged on the thirteenth postoperative day.

Conclusion In selected patients, minimally invasive surgery can be employed in primary cytoreductive surgery for advanced ovarian carcinoma, improving postoperative outcomes for the patient without compromising surgical radicality.

Disclosures No.