Design: Stepwise surgical film.

Setting: A hospital.

Patients or Participants: The patient was 29-year-old G0P0 presenting with a strong desire for fertility preservation who had low-grade serous adenocarcinoma after a laparoscopic left ovarian cystectomy in another hospital. The operative record showed intraoperative cyst rupture.

Interventions: Transumbilical laparoendoscopic single-site surgery has significant advantages in minor incision, specimen retrieval, slight pain and rapid recovery. The feasibility and safety of ovarian cancer staging surgeries through single-site approach have been proved. However, the risk of intraoperative complications during transperitoneal lymphadenectomy including vascular, intestinal and ureteral injuries is increasing due to lack of assistance. Previous studies reported lateral extraperitoneal approach to achieve better exposure and dissection of para-aortic lymph nodes with lower risk of complications, while bilateral obturator regions were poorly explored. We designed an innovative extraperitoneal approach through the same umbilical incision which achieves satisfactory visualization and lymph nodes retrieval of both pelvic and para-aortic areas. We found it particularly suitable for fertility-sparing because it can maintain intact peritoneum and reduce intraperitoneal adhesion, which might contribute to future pregnancy.

Preoperative staging of this patient was stage IC1. The whole surgical procedures were completed through a 2cm umbilical incision. Development of the extraperitoneal approach including purse string suture and posterior peritoneal incision above the aortic bifurcation was completed under laparoscopy. An appropriative port was inserted into the extraperitoneal space to perform lymphadenectomy. Other concomitant procedures were completed intraperitoneally.

Measurements and Main Results: The total operative time was 230min with 200ml blood loss. The patient was discharged in 3 days and no complications occurred. Pathology examination revealed no residual tumor in all specimens which made the postoperative stage keep as IC1.

Conclusion: Transumbilical laparoendoscopic single-site extraperitoneal approach is of great advantage in fertility-sparing staging surgery for epithelial ovarian cancer.