Da Vinci® SP Robot for Minimally Invasive Advanced Ovarian Cancer: Debulking of Enlarged Lymph Nodes

Abstract

Traditionally, advanced ovarian cancer (AOC) is treated with debulking surgery via laparotomy.1 Recently, minimally invasive surgery (MIS), including robotic-assisted techniques, has been introduced for select early stage cases. However, robotic systems, especially multiport setups, often struggle with full abdominal access, which can compromise tumor assessment. 2 The da Vinci robotic single-port (SP) system is a new advancement allowing access to all abdominal quadrants through a single umbilical incision without needing to redock. 3 This video presents an initial case using the da Vinci SP for debulking surgery in a patient with incidentally discovered advanced ovarian cancer. The patient had previously undergone bilateral adnexectomy at another center for ovarian cancer, with no initial signs of intraperitoneal disease. Preoperative imaging and cancer antigen (CA)-125 were negative, leading to the decision to proceed with MIS restaging surgery. No new diagnostic laparoscopy was performed based on recent findings. Da Vinci SP was used. Intraoperatively, unexpected advanced disease was found, including a 4 cm rectal wall nodule and bulky bilateral pelvic lymph nodes. The surgical procedure included radical hysterectomy, pelvic peritonectomy, bilateral lymph node debulking, and rectal shaving using the SP system. The procedure lasted 180 min with 150 mL blood loss, no conversion to open surgery, and no complications. The patient was discharged after 48 h. This case suggests the feasibility of using the da Vinci SP system for complex debulking in selected patients with AOC. Its improved instrument flexibility supports multiquadrant operations. However, broader trials such as the LANCE trial 4 are necessary to establish its role in standard AOC treatment (Fig. 1).3