Application of Sentinel Lymph Node Technique to Transvaginal Natural Orifices Transluminal Endoscopic Surgery in Endometrial Cancer

Abstract

Study objective: This report outlines our first experience of sentinel lymph node (SLN) mapping in the natural orifices transluminal endoscopic surgery (NOTES) technique, which is the combination of the least invasive surgical approach and the least invasive way of assessing lymph node status.

Design: Descriptive study (Canadian Task Force classification III).

Setting: Tertiary referral and educational center.

Patients: Four patients with endometrial cancer clinical stage 1.

Interventions: NOTES with SLN mapping using an indocyanine green-based near-infrared fluorescence imaging technique.

Measurements and main results: The average operative time was 182.75 minutes (standard deviation, 34.5). Mean estimated blood loss was 67.5 mL (standard deviation, 39.4). All patients had surgical staging of International Federation of Gynecology and Obstetrics stage IA (pT1aN0). The overall detection rate and bilateral detection rate were 100% (4/4). All procedures were successfully completed without complication or conversion to conventional laparoscopy.

Conclusion: In our preliminary experience, SLN mapping in NOTES surgery appears to be feasible and safe. It can be considered as an alternative method to reduce morbidity from radical lymphadenectomy and provide the benefits from the NOTES technique. However, studies in a larger population are necessary.

Keywords: Endometrial cancer; Indocyanine green (ICG); Lymphadenectomy; Natural orifice transluminal endoscopic surgery (NOTES); Sentinel lymph node.