A novel technique for transdiaphragmatic latero-pericardial cardiophrenic lymph node excision using the minimally invasive surgical access procedure in patient with advanced stage ovarian cancer

This study reports the first case of transdiaphragmatic lateropericardial cardiophrenic lymph node excision using the GelPOINT™ mini access platform in a patient with advanced-stage ovarian cancer. A 69-year-old woman with high-grade serous epithelial ovarian cancer. Cardiophrenic lymph node dissection is vital in advanced ovarian cancer surgery, as enlarged nodes are linked to poor prognosis. No clear guidelines exist for operating on patients with enlarged cardiophrenic lymph nodes [1,2]. These nodes are categorized by location relative to the heart: anterior, median (lateropericardial), and posterior [3]. Cardiophrenic lymph node resection can be performed using transdiaphragmatic, transxiphoid, or transthoracic approaches with video-assisted thoracoscopic surgery [4]. In cases with suspicious nodes on imaging, removing them is essential for optimal cytoreduction and accurate staging. In this case, preoperative computed tomography revealed suspicious cardiophrenic lymph nodes measuring 16×13 mm and 10×8 mm, located near the xiphoid process and lateral pericardium. A 30 mm diaphragm incision was made 60 mm from the xiphoid process. An Alexis O-wound retractor was used, and the GelPOINT™ mini platform was introduced with three ports, including one for the camera. A 30-degree optic scope was used to excise the node with LigaSure. When we needed smoke management, we used an aspirator. With this method, we were able to access distally located cardiophrenic lymph nodes with a small incision. Transdiaphragmatic excision of the cardiophrenic lymph node using the mini access platform can be performed effectively with a smaller incision, demonstrating the feasibility and safety of this minimally invasive technique in managing such cases.