**1. Introduction**

The most common gynaecological cancer treated in women is uterine cancer, however the number of women who die from ovarian cancer is much higher [1]. Ovarian cancer has remained the most lethal cancer treated by gynaecological oncological surgeons and is often referred to as the "silent killer".

Ovarian cancer is the 7th most common cancer, and 8th most common cause of death from cancer in women in the world [2]. World Ovarian Cancer Coalition 2018 estimated that by 2035, the incidence of ovarian cancer will increase to 371, 000 per year. It is currently around 239, 000 cases annually [2]. The crude incidence is 23 to 30 in 100 000 women and most women present with advanced disease and little prospect of cure; the five-year survival rate for all stages of ovarian cancer is just over 40% and has remained quite low [3].

The treatment for patients with ovarian cancer is debulking surgery and platinumbased chemotherapy. The amount of residual disease after surgery is the most important prognostic factor for survival [4–11] and a recent phase III clinical trial [9]

confirmed this finding. Debulking surgery is a multi-visceral operation involving the pelvis, lower and upper abdomen, aiming at a complete resection (CR) of all visible disease to a microscopic cellular level [8–11]. This is also called cytoreductive surgery.

We present the latest surgical developments in ultra-radical surgery for the management of advanced ovarian cancer.
