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Ovarian cancer is one of the most common gynecological malignancies and is usually diagnosed at an advanced stage.1 Accurate cancer staging and optimal cytoreduction are vital for prediction of prognosis and adjuvant therapy. The laparotomy approach is the traditional option for this procedure. However, recent studies also suggest that robotic surgery is an alternative option for appropriately selected patients with advanced ovarian cancer, without extensive dissemination (absence of ascites and carcinomatosis) intraperitoneally, due to its favorable perioperative outcomes and early onset chemotherapy without affecting survival rates.2–4
Data on primary debulking surgery for advanced ovarian cancer by the robotic single port approach are limited. Transumbilical single port surgery has potential benefits in terms of safe tissue extraction, increased cosmetics, and reduced pain and incisional morbidity over multi-port access. Our video demonstrates the feasibility and safety of primary debulking surgery for selected advanced stage epithelial ovarian cancer by the transumbilical single port approach using the da Vinci Xi surgical system.
The patient in her 50 s had suspected ovarian cancer with gross lesions confined to the pelvis and an isolated enlarged para-aortic lymph node that was considered to be a metastasis. A 3 cm vertical umbilical incision was made for the entire surgery. After completion of the pelvic procedures, the da Vinci Xi system were dual docked towards the upper abdomen for para-aortic lymphadenectomy up to the renal vein. The enlarged node was carefully resected without vascular injury. Satisfactory debulking was achieved with no macroscopic lesions under the robotic enhanced amplification of view.
We believe that the robotic transumbilical single port approach is feasible and safe for selected patients with advanced ovarian cancer. The procedure requires only one incision to reach an extensive operational field from the upper abdomen to the deep pelvis. It is simple and time saving for dual docking of the da Vinci Xi system by rotating the arm beam for 180 degrees without changing the cart’s position or adding ports. The precise movement and improved visualization of the robotic system will help resection of metastatic lymph nodes that are densely adhesive to the vascular wall without injury. To date, we have successfully completed primary debulking surgery in three cases of stage III epithelial ovarian cancer. Sufficient evaluation and extensive surgical experience are required before conducting this complex procedure.
Right ovarian mass.
Enlarged lymph node.
Data availability statement
All data relevant to the study are included in the article.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by the institutional review board of West China Second University Hospital (No: 2023053). Participants gave informed consent to participate in the study before taking part.
Footnotes
Contributors YC contributed to video editing and manuscript preparation. YZ is responsible for the overall content as the guarantor and the main surgeon. FY was the assistant surgeon.
Funding This work was supported by the National Key Research and Development Program of China (2022YFC2704103) and the Key Science and Technology Projects of Sichuan Province (2021YJ0137).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.