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Robotic staging for early ovarian cancer in 10 steps
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  1. Aniello Foresta1,
  2. Filippo Maria Capomacchia1,
  3. Camilla Certelli1,
  4. Chiara Caricato1,
  5. Anna Fagotti1,2,
  6. Giovanni Scambia1,2 and
  7. Valerio Gallotta2
    1. 1Institute of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
    2. 2Department of Women's, Children's and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
    1. Correspondence to Dr Aniello Foresta, Department of Women's, Children's and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy; anielloforesta{at}gmail.com

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    One-third of patients with ovarian cancer are diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I-II,1 and their 5-year survival ranges between 80% and 90%.1 The standard treatment for early ovarian cancer patients includes complete surgical staging to establish a diagnosis, remove the tumor, and assess the extent of the disease.2 The histological subtypes of early ovarian cancer, the tumor grade, and the final FIGO stage are the main prognostic factors. Apparently early ovarian cancer sometimes presents microscopic disease in the upper abdomen or retroperitoneum and the upstaging rate reported in the literature varies from 4.5% to 38.5%. According to ovarian cancer guidelines, the standard approach for surgical staging in early ovarian cancer is laparotomy, although minimally invasive surgery may be used by an experienced surgeon in selected patients.2 3 Minimally invasive surgery has been successfully employed in patients with early ovarian cancer presenting a lower incidence of morbidities, apparently without compromising oncological outcomes.4

    The tumor diameter and adhesions to ovarian fossa peritoneum play an important role in the selection of patients for minimally invasive surgery, since they are associated not only with a higher risk of capsule rupture but also with a higher risk of conversion to laparotomy.

    Surgery was carried out in an Italian tertiary care University hospital. The surgical procedure was divided into the following 10 steps (Video 1):

    Video 1 Robotic staging for early ovarian cancer in 10 steps

    Step 1: Diagnostic laparoscopy.

    Step 2: Bilateral access to the pelvic retroperitoneum.

    Step 3: Identification of the ureter and development of the medial and lateral pararectal and paravescical spaces.

    Step 4: Closure of the uterine artery at the origin, bilateral section of ovarian pedicles, and mobilization of the adnexal mass with “no touch” isolation technique.

    Step 5: Development of the recto-vaginal and vescico-vaginal septum.

    Step 6: Total hysterectomy and bilateral salpingo-oophorectomy.

    Step 7: Endobag extraction of surgical specimen and frozen section.

    Step 8: Infracolic omentectomy.

    Step 9: Central access to the lumbo-aortic field.

    Step 10: Visualization and dissection of paracaval, para-aortic, and pelvic lymph nodes.

    In conclusion, the robotic approach can be safely used in oncological centers, by expert surgeons, in well-selected patients, with apparently early-stage ovarian cancer.

    Figure 2

    Exposure of the lombo-aortic field, visualization, and dissection of paracaval, supramesenteric, and inframesenteric para-aortic lymph nodes.

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    References

    Footnotes

    • X @chiara.caricato, @annafagottimd

    • Contributors AFo: Conceptualization, video editing, and writing original draft. FMC: Conceptualization, video editing, and writing original draft. CCe: Conceptualization, video editing, and writing original draft. CCa: Conceptualization, video editing, voice over, and writing original draft. AFa: Conceptualization, project administration, supervision, and writing review. GS: Conceptualization, project administration, supervision, and writing review. VG: Conceptualization, project administration, surgery and video recording, supervision,

      guarantor and writing review.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.