Ovarian cancer carries the highest mortality among all gynaecological malignancies. This is mostly due to the fact that most patients present with advance disease. In these cases optimal debulking of the tumour becomes absolutely essential for the survival of these patients, as the size of residual tumour after surgery has been shown to be an important prognostic factor.  In advance ovarian cancer, we often encounter tumour deposits on bowel, mesentery, bladder and peritoneum.  Thus to achieve optimal cytoreduction, these tumour deposits need to be removed. The risk of injury to these organs is always a concern to the surgeon. Thus we would like to introduce a technique of removing these deposits with ease and without compromising the organ’s integrity or vascular supply.

In a prospective observational study of 7 patients with advanced ovarian cancer, we have used this technique to achieve optimal cytoreductive surgery. The technique uses a colposcopy loop used in cervical excision procedures. By using monopolar current at 30 watts, superficial excision of tumour deposits over the bowel, mesentery and peritoneum can be performed. The beauty of the loop is that it’s a fine thin wire, allowing us to remove the tumour with adequate tissue margin without compromising the vasculature and tissue integrity below. The risk of injuring blood vessels or breaching the mucosa of tissues beneath the tumour is remote. The energy current that we use is also safe and does not increase the risk of thermal injury. The procedure is quick, highly effective, and easy to teach and learn with minimal complications. 

Primary optimal cytoreductive surgery followed by adjuvant therapy would definitely improve a patient’s prognosis, outcome and survival. The Gynaecologic Oncology group currently defines ‘optimal’ as having residual tumour nodules each measuring 1 cm or less in maximum diameter, with complete cytoreduction being the ideal surgical outcome. To achieve this, we must endeavour to ensure all tumour nodules are removed even if its location is unfavourable such as those attached to the bowel, bladder or diaphragm. By using this technique, almost all tumour nodules can be removed with ease without any injury or complications.