How to perform complete resection of peritoneal carcinomatosis nodules infiltrating the diaphragm without opening the pleural cavity in patients with advanced-stage ovarian cancers

Patients with advanced-stage ovarian cancer frequently present with peritoneal carcinomatosis, and a diaphragmatic involvement is observed in about 40% of cases. The goal of treatment includes complete surgical cytoreduction associated with systemic chemotherapy. Complete diaphragmatic cytoreduction is a crucial step and plays a major role in the overall survival of these patients. Deep infiltrating peritoneal carcinomatosis nodules are treated with diaphragmatic full-thickness resections, but these procedures involve opening the pleural cavity and are associated with a high rate of postoperative complications, such as pleural effusion and pneumothorax. A chest drain is often required, causing significant discomfort for the patients and potentially being an additional source of complications. In this study, we present a novel surgical technique to perform diaphragmatic resections using a linear stapler without opening the pleural cavity or needing a chest drain.