as a minimally invasive technique , laparoscopic surgery is widely used in benign gynecologic diseases and may also be used in malignancies such as endometrial cancer , cervical cancer , and early ovarian cancer . recent studies have demonstrated that laparoscopic surgical staging of early ovarian cancer is as safe and adequate as open laparotomy . technologic advances in endoscopic instrumentation and optics have allowed the development of a less invasive alternative to conventional laparoscopy ; single - port access ( spa ) laparoscopic surgery . by using a single multichannel port access system , spa laparoscopy is an attempt to further enhance the cosmetic benefits of minimally invasive surgery while minimizing the potential risks and morbidity associated with multiple working ports . in addition , it was proved that spa laparoscopic adnexal surgery had comparable operative outcomes to conventional laparoscopic adnexal surgery . in gynecologic malignancy , there is one case series that included two patients who had received lymph node dissection during the staging operation . the number of harvested lymph node in the two patients was only 11 and 13 , respectively . here we report a case of borderline ovarian tumor treated with spa laparoscopic staging operation . a 34-year - old woman , gravida 2 , para 2 , visited our clinic with an incidentally found right ovarian cyst . on pelvic examination transvaginal ultrasonography revealed a 4.03.8 cm sized mixed - echogenic right ovarian cyst ( fig . 1 ) . the results of laboratory studies , including analysis of tumor markers , such as ca125 , ca19 - 9 , were all within normal limits ( ca125 , 5.9 ; ca19 - 9 , 30.2 u / ml ) . she had received two cesarean sections with a transverse incision , and had no plans for further children . her height was 160.1 cm and weight was 60.3 kg with a body mass index of 23.53 kg / m . as the result of intraoperative frozen biopsy of right ovary was a borderline tumor , we decided to change the method of surgery to a staging laparoscopy . the total operative time was 280 minutes , and the estimated blood loss was 300 ml . on gross examination , the right ovary was enlarged and had a smooth cyst about 4 cm in size , but no other abnormalities were identified . pathological examination showed a mucinous borderline tumor of the right ovary and patient 's surgical stage was diagnosed as ia . initial hemoglobin level was 14.3 g / dl , and follow - up level was 13.2 g / dl on the postoperative day 1 . visual analogue scores for pain at 4 hours and 24 hours after surgery were 6/10 and 4/10 retrospectively . she was discharged on the postoperative day 7 after the final pathologic result was confirmed . the surgeon stood on the left side of the patient , and the first assistant stood on the right side of the patient to handle the scope . the second assistant was positioned between the legs of the patient , manipulating the uterine elevator . the patient 's left arm was tied to her body for the surgeon 's space . a 2-cm vertical intra - umbilical skin incision was performed via an open hasson approach . the alexis wound retractor ( applied medical , rancho santa margarita , ca , usa ) was inserted through the incision . then a sterile surgical glove with sheaths inserted into 3 fingers was draped around the rim of the wound retractor . we used a rigid 45-degree , 5-mm laparoscope ( ideal eyes 5 mm 45 deg , stryker , san jose , ca , usa ) and 5-mm flexible laparoscope instruments ( e.g. , roticulator , covidien , mansfield , ma ; cambridge endoscopic devices , framingham , ma , usa ) . , we used a harmonic scalpel ( harmonic ace , ethicon endo - surgery inc . , bilateral pelvic lymph node dissection , infracolic omentectomy , and appendectomy were performed using a harmonic scalpel on the right hand and a roticular dissector on the left hand ( fig . the omentum , appendix , uterus , and left salpinx and ovary were removed through the vagina . another opening was made on the suprapubic area to place a jackson - pratt drain in the pelvic cavity . the trocar was introduced into the pelvic cavity through the suprapubic skin and extracted via the umbilical incision site manipulating with a grasper ( fig . 4 ) . the peritoneum and fascia of the umbilical opening were approximated and closed layer by layer with 2 - 0 polysorp ( covidien syneture , norwalk , ct , usa ) suture . for skin closure , we used dermabond ( ethicon inc , somerville , nj , usa ) , which provided a good cosmetic outcome and did not require later stitching out . the surgeon stood on the left side of the patient , and the first assistant stood on the right side of the patient to handle the scope . the second assistant was positioned between the legs of the patient , manipulating the uterine elevator . the patient 's left arm was tied to her body for the surgeon 's space . a 2-cm vertical intra - umbilical skin incision was performed via an open hasson approach . the alexis wound retractor ( applied medical , rancho santa margarita , ca , usa ) was inserted through the incision . then a sterile surgical glove with sheaths inserted into 3 fingers was draped around the rim of the wound retractor . we used a rigid 45-degree , 5-mm laparoscope ( ideal eyes 5 mm 45 deg , stryker , san jose , ca , usa ) and 5-mm flexible laparoscope instruments ( e.g. , roticulator , covidien , mansfield , ma ; cambridge endoscopic devices , framingham , ma , usa ) . , we used a harmonic scalpel ( harmonic ace , ethicon endo - surgery inc . , 2 ) . bilateral pelvic lymph node dissection , infracolic omentectomy , and appendectomy were performed using a harmonic scalpel on the right hand and a roticular dissector on the left hand ( fig . the omentum , appendix , uterus , and left salpinx and ovary were removed through the vagina . another opening was made on the suprapubic area to place a jackson - pratt drain in the pelvic cavity . the trocar was introduced into the pelvic cavity through the suprapubic skin and extracted via the umbilical incision site manipulating with a grasper ( fig . 4 ) . the peritoneum and fascia of the umbilical opening were approximated and closed layer by layer with 2 - 0 polysorp ( covidien syneture , norwalk , ct , usa ) suture . for skin closure , we used dermabond ( ethicon inc , somerville , nj , usa ) , which provided a good cosmetic outcome and did not require later stitching out . the major principle of minimally invasive surgery is to be less invasive , leading to less physiologic stress , faster recovery , and better cosmetic results . from a technical standpoint , spa laparoscopy in the field of minimally invasive surgery is the most recently emerging and promising method . in 1994 , querleu and leblanc   first demonstrated that laparoscopic surgery may be used to adequately stage ovarian malignancies . since then , several investigators reported some cases of laparoscopic surgical staging of early ovarian cancer ( eoc ) . described that laparoscopic surgical staging of eoc is as safe and adequate as the standard surgical staging performed via laparotomy , and offers a shorter hospital stay . in 2009 fader and escobar   first demonstrated in a series of patients referred for staging that spa laparoscopic surgery may be used to adequately stage ovarian malignancies . the study of two port access staging laparoscopy was reported recently as a feasible procedure in selected gynecologic cancer patients . in accordance with a previous study , we demonstrated that staging operation of early ovarian cancer may be performed using spa laparoscopy . furthermore , the number of lymph nodes in this case is sufficient compared to the results of other studies . consequently , spa laparoscopic staging of early ovarian cancer may be accomplished successfully with pelvic lymph node dissection , for patients whose disease appear to be limited to the adnexa first , paraaortic lymph node dissection was not done due to technical difficulty and a high risk of complications . second , at the end of the operation , another 3 mm puncture on the suprapubic area was needed to insert the drain tube . recent meta - analysis reveals that placement of retroperitoneal tube drains has no benefit in the prevention of lymphocyst formation after pelvic lymphadenectomy in patients with gynecological malignancies . based on this analysis , the drainage system may be omitted in future cases . in conclusion , staging operation using spa laparoscopy was successfully done , and it may be a feasible procedure in selected gynecologic cancer patients who have early - staged ovarian or endometrial cancer , and who are concerned for postoperative scarring . the efficacy , safety , and potential benefits of this technique in cancer staging operation should be evaluated in further trials .