Design: N/A

Setting: The patients included in this video underwent straight-stick laparoscopy. Patients were placed in lithotomy position. Four laparoscopic ports were utilized in the following locations: umbilicus, left lower quadrant, right lower quadrant and suprapubic.

Patients or Participants: The patient in this video is a 68 year old with a history of stage IB high grade serous ovarian cancer previously treated with cytoreductive surgery and adjuvant chemotherapy who presented with a.1.59cm x 0.7cm x 1.0cm left sided solid mass concerning for recurrence. The patient underwent diagnostic laparoscopy with resection of the pararectal mass, which was found to be continuous and inseparable from the vaginal cuff. The pararectal space was developed laparoscopically and the mass was noted to be closely adherent to the right ureter. With careful blunt and sharp dissection, the mass was able to be dissected away from both the ureter and pararectal space.

Interventions: N/A

Measurements and Main Results: N/A

Conclusion: Thorough understanding of the pelvic sidewall anatomy is necessary for laparoscopic debulking of pelvic sidewall masses. Masses closely adherent to the ureter require dissection with careful blunt dissection and cautious utilization of thermal energy in order to avoid ureteral energy including thermal injuries. Since secondary cytoreductive surgery, the patient has remained no evidence of disease.