Design: Retrospective review of patients diagnosed with cancer who underwent laparoscopy.

Setting: Patients were all undergoing the same standardized laparoscopy techniques for fertility/pain disorders.

Patients or Participants: All cases of malignancies (n=4) in 3 years by a single surgeon were included.

Interventions: Surgeon utilized the Near-Contact Laparoscopy (NCL) and Systematic Mapping of the Abdomen and Pelvis (S-MAP) techniques for finding and curative treatment of 4 cancers.

Measurements and Main Results:

Case A. In the NCL/S-MAP surgery, a 2 mm lesion of Well-differentiated papillary mesothelioma (WDPM) was found.

Case B: 27 yo G0 presented for a second opinion for ongoing pain after surgery. Pathology- neuroendocrine tumor, 0.5 mm.

Case C: 33 year old G3P2012 with irregular cycles, dysmenorrhea, and infertility. With NCL/S-MAP surgery, NCL/S-MAP surgery removed stage IV Neuroendocrine appendix tumor plus 2 cancer lesions from the pelvis (0.3 to 0.8 cm). With oncology, she underwent hemicolectomy which was clear. After two years, she is in remission.

Case D: 27 yo G1P1 was recommended to undergo hysterectomy after laparoscopy when seeking fertility. NCL/S-MAP surgery findings: appendiceal/terminal ileum/cecal mass, bilateral endometriomas, frozen pelvis. Appendectomy with partial cecectomy: neuroendocrine tumor of appendix. Further work up negative for malignancy. FSH 34.6. Achieved pregnancy after additional surgeries, adhesion prevention (Goretex) and medical management.

Discussion: Three out of four of these cancers were neuroendocrine tumors of the appendix (incidence 0.95 in 100,000). The likelihood of 3 cases found by a single surgeon are 0.0000000001. WDPM is only in case reports. This suggests surgical technique that these cancers (with low mortality rates) are missed at laparoscopy.

Conclusion: This case series suggests that systematic, thorough laparoscopy can be highly effective when using a NCL/S-MAP approach. Standardization should be incorporated as the gold standard.