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Objective: To show a surgical video in which an isolated mass was resected off the external iliac vessels for the management of recurrent ovarian cancer., Design: Case report., Setting: Tertiary referral center in New Haven, Connecticut., Interventions: This is a step-by-step demonstration of a robotic tumor debulking in a patient with isolated recurrence of epithelial ovarian cancer [1-3]. The patient is a 70-year-old woman with Lynch syndrome who received a diagnosis for stage IIC high-grade serous ovarian adenocarcinoma and underwent complete debulking in 1996. She had most recently been on pembrolizumab for microsatellite instability-high tumor until February 2019, when she received a diagnosis for isolated hypermetabolic mass in close proximity to the external iliac vessels and right iliac fossa. The patient was placed in dorsal low lithotomy Trendelenburg position, and 15° leftward tilt of the table was obtained to expose the right pelvic sidewall and iliac fossa. To optimally target the surgical field of interest, all robotic trocars were placed in a straight line starting from 5 cm above symphysis pubis on the left side to left subcostal line between the midline vertical and the left midclavicular lines, as per the manufacturer's port placement guidelines (Fig. 1)., Conclusion: Robotic resection of the tumor nodule off the external iliac vessels was successfully performed with adequate range of motion provided by the arms and without any complications. Trocar placement should be tailored to the site of surgical interest. Robotic-assisted laparoscopy should be considered as a valid alternative to the traditional open approach, when managing solitary masses in patients with recurrent ovarian cancer., (Copyright © 2019 AAGL. Published by Elsevier Inc. All rights reserved.)

Study Objective: To demonstrate a surgical video of laparoscopic management of an appendiceal mass preoperatively misdiagnosed as a pelvic mass. This study was deemed to be exempt from the Yale New Haven Hospital Institutional Review Board., Design: A step-by-step explanation of the diagnosis and laparoscopic management of an appendiceal mass using an instructive video (Canadian Task Force classification III)., Setting: A teaching hospital in New Haven, Connecticut., Patient: A 53-year-old multiparous perimenopausal woman., Intervention: Laparoscopic management of an appendiceal mass., Measurements and Main Results: A 53-year-old multiparous perimenopausal patient underwent workup for pelvic pain. Pelvic imaging revealed a 72 × 35 × 28 mm cystic structure abutting the uterine fundus with thin partial septum but no mural nodules or concomitant pelvic lymphadenopathy. Exploratory laparoscopy showed unremarkable pelvic anatomy. After the entire small bowel was run, the cystic structure abutting the uterine fundus was deemed to be an appendiceal mass. The observed convergence of the 3 taeniae coli at the junction of the cecum with the cystic mass confirmed the diagnosis. For laparoscopic resection the umbilical fold port site was extended to 12 mm to introduce the Endo GIA stapler (Medtronic, Minneapolis, MN). The appendiceal mass was stabilized in view with a laparoscopic grasper, and the stapler was articulated to fit the base of the appendix without narrowing the lumen of the cecum. The specimens were removed through the umbilical port site in a laparoscopic bag without spillage. Pathology returned low-grade appendiceal mucinous neoplasm with no evidence of invasion. The patient was managed appropriately with laparoscopic appendectomy and discharged home on the day of surgery., Conclusion: Appendiceal masses should be considered in the differential diagnosis of a presumed pelvic mass. For low-grade appendiceal mucinous neoplasms that are diagnosed intraoperatively, laparoscopic resection without spillage or rupture is a feasible and appropriate approach for treatment [1-3]., (Copyright © 2018 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to compare the incidence of lower extremity lymphedema in patients with uterine cancer after robotic staging using the following 2 methods: standard and selective pelvic lymphadenectomy., Materials and Methods: Three hundred forty-four consecutive patients who presented with endometrial cancer from March 2007 to October 2012 underwent robotic staging. Surgeon A performed standard pelvic lymphadenectomy and surgeon B performed selective lymphadenectomy. Selective pelvic lymphadenectomy spared the lateral chain of the external iliac lymph nodes (LNs). The incidence of lymphedema and staging adequacy between the 2 groups were analyzed., Results: Standard pelvic lymphadenectomy was performed in 238/344 (69.2%) patients and selective pelvic lymphadenectomy was performed in 106/344 (30.8%) patients. Conversion to laparotomy occurred in 2/344 cases (0.6%). Mean age for 344 patients was 63.6 (10) years and body mass index was 34.8 (10.1) kg/m(2). The mean operative time was 162.3 (54.6) minutes. Postoperative hospitalization was 1.62 (1.93) days. Histology included 80.8% endometrioid adenocarcinomas and 19.2% clear cell, serous, and carcinosarcomas. Mean pelvic LN counts for the standard and selective pelvic lymphadenectomy groups were 16 (8.6) and 15.5 (7.1), respectively (P = 0.31). Mean numbers of para-aortic LNs retrieved for the standard and selective lymphadenectomy groups were 3.1 (4.1) and 4.9 (4.5), respectively (P < 0.01).Median follow-up was 29.3 months (interquartile range, 15.6-43.1 months). The difference in the incidence of lower extremity lymphedema was statistically significant: 4.6% (11/238 patients) in the standard lymphadenectomy group versus 0.9% (1/106 patients) in the selective lymphadenectomy group (P = 0.03)., Conclusions: When compared to the standard technique, selective pelvic lymphadenectomy with sparing of the lateral chain of the external iliac LNs is adequate and results in a lower incidence of lower extremity lymphedema.