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Estimated, 225,000 new cases of ovarian cancer in the world in 2011, with approximately 140,000 deaths. In the United States of America, ovarian cancer is the second most gynecological cancer. It is the most common cause of gynecological cancer related death primarily because most patients present with advanced disease. 65-70% of patients are diagnosed at an advanced stage, conferring a 5-year survival rate of 30-55%. Epithelial ovarian cancer (EOC) remains the most lethal gynecologic cancer in the United States. In 2010, approximately 21,880 new cases and 13,850 deaths occurred. There is no proven screening test for this disease. Many women present with vague symptoms, including abdominal bloating, change in bowel or bladder habits, early satiety, or abdominal pain. It is diagnosed at advanced stage for about 75% of patients [1]. It spreads along the peritoneal surfaces to the upper abdomen by direct extension or by peritoneal implantation [2]. Metastases to the diaphragm, especially to the right hemi-diaphragm, are common in patients with advanced ovarian cancer. About 40% of patients with advanced ovarian cancer present with bulky metastatic diaphragmatic disease. About 19% of patients are diagnosed with International Federation of Obstetrics and Gynecology (FIGO) [Table 1.] stage I disease, in which the tumor is confined to one or both ovaries. (1). Stage I disease is usually diagnosed incidentally during laparoscopic or laparotomy surgery for benign-looking ovarian tumors, but, following complete staging, it is upstaged in 30% of patients due to microscopic metastatic disease.(2,3 ). FIGO guidelines have stated that the standard management for apparent early-stage disease is complete surgical staging, including total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection, infracolic omentectomy, multiple peritoneal washing, and multiple peritoneal biopsies (4). Initial evaluation includes a thorough history and physical examination, imaging studies such as MRI and computerized tomography scanning, assessment of tumor markers such as CA-125, biopsies, cystoscopy and colonoscopy. The standard treatment for primary ovarian cancer consists of maximum cytoreductive effort to reduce residual tumor (RT), followed by platinum-based chemotherapy (3, 4). It has been shown that cytoreduction has a more significant influence on survival than the extent of a

Minimally Invasive Surgical Procedures for Patients with Advanced and Recurrent Ovarian Cancer