LAUSR

Recurrent ovarian cancer is usually associated with complex pelvic conditions. The variable location of metastatic tumors and intestinal adhesions make secondary cytoreductive surgery difficult. In order to provide appropriate surgery, gynecologic oncologists working in medical centers where many gynecological surgeries are performed are required to be accomplished in urological, vascular, and gastrointestinal surgery. The aim of Video 1 is to introduce minimally invasive surgical techniques used in secondary cytoreductive surgery of recurrent ovarian cancer for gynecologic oncologists. All the procedures demonstrated in this video were performed by gynecologic oncologists. A 58yearold woman was diagnosed with peritoneal carcinomatosis. In 2018, she received primary debulking surgery which included laparoscopic hysterectomy, bilateral adnexectomy, pelvic and paraaortic lymphadenectomy, and infragastric omentectomy. The postoperative pathology revealed a highgrade serous adenocarcinoma that was International Federation of Gynecology and Obstetrics (FIGO) stage IIB. She started adjuvant chemotherapy 3 weeks after the surgery for six cycles. A comprehensive evaluation suggested a complete response. However, in February 2020, a positron emission tomography/computed tomography (PET/CT) scan showed tumors on the ileum, sigmoid colon, left pelvic brim, and near the bladder. There were no other tumors in the upper abdomen or extraabdominal region, so this patient was eligible for secondary cytoreductive surgery. We first placed a stent into the ureter on both sides. As the bottom of the tumor was initially hard to expose, we first separated the tumor from the left extreme which densely adhered to the left pelvic brim. Next, we distinguished and cut off the superior rectal arteries and veins and their branches. After that, the ureter and internal iliac vein were separated from the tumor. Finally, we performed the colorectal anastomosis using the doublestapled anastomosis technique. The operation lasted about 350 mins. The total intraoperative blood loss was