Introduction Gynecologic tumors, especially ovarian cancer, have a high incidence of metastasis to the lymph nodes of cardiophrenic angle. If R0 resection can be achieved in the abdominal and pelvic cavities, removal of the lymph nodes in the cardiophrenic angle can achieve true systemic R0 resection, which can improve the patient‘s prognosis. The video aims to showcase the technical advantages of this approach while also highlighting the challenges associated with mesonephric duct carcinoma, such as Low incidence rate, difficult preoperative diagnosis, and insensitive to chemotherapy.

Description The incision is made on the outer edge of the breast between the fourth and sixth ribs, with a 5mm trocar and a 2cm small incision. The cardiophrenic angle area is filled with adipose tissue, and the metastatic lymph nodes are surrounded by the adipose tissue. Therefore, to achieve R0 resection, the adipose tissue must be completely removed. Firstly, the entire fat tissue mass is dissected from the front of the diaphragm and towards the direction of the pericardium. When we see the muscle tissue of the diaphragm, it indicates that the fat has been stripped thoroughly. When the fat on the diaphragmatic and chest wall is completely loosened, the fat in the cardiophrenic angle can be completely removed along the pericardial side. When the dissection is completed, insert a No.22 closed thoracic drainage tube. Finally, close the incision.

Conclusion/Implications Thoracoscopic cardiophrenic angle lymphadenectomy is feasible and safe. Compared to the abdominal approach, thoracoscopic cardiophrenic lymph node dissection provides a better view, easier operation, and more thorough cleaning.