Robotic transumbilical single-site re-staging surgery of ovarian granulosa cell tumor - case report and technical points with video

Introduction:Robotic laparo-endoscopic single-site (R-LESS) surgery is a potential advancement from the conventional single-site surgery in minimally invasive surgery (MIS) management for early ovarian cancer including granulosa cell tumors. This case report details the use of a novel robotic surgical system for a trans-umbilical single-site re-staging procedure to assess its feasibility and safety. It also discusses the technical challenges encountered during omentectomy, one of the most challenging steps of the surgery, since it requires changing of instrument direction from pelvic to abdominal area.Case presentation:We presented a case of a female in 40 years old who came to our hospital for a re-staging surgery. She underwent open abdominal right ovarian and fallopian tube resection in local hospital, and post-operative pathology reported ovarian granulosa cell tumor. Since she insisted to have MIS, robotic laparo-endoscopic trans-umbilical single-site re-staging surgery was planned for her. The scope of the surgery was total hysterectomy, left ovarian and fallopian tube resection, and omentectomy. The whole surgery took 240 min. Console time was 173 min. Intra-operative bleeding was 50 mL. The patient left our hospital 3 days after surgery with no complications.Discussion:Ovarian granulosa cell tumor is not common. Staging can be performed under MIS in highly selected patients. During infra-colic omentectomy, spaces were rather narrow for valid movement of robotic arms. To solve this problem, assistant played crucial role for traction and exposure.Conclusion:To conclude, single-site robotic surgery was feasible for staging of ovarian granulosa cell tumor with highly selected patients.