Single site robotic sentinel lymph node biopsy and hysterectomy in endometrial cancer

Sentinel lymph node (SLN) biopsy has been proposed as a safe and less morbid approach to full lymphadenectomy in endometrial cancer (EC) [1,2]. The role of single incision robotic surgery (SIRS) remains unclear in this setting [3,4]. The aim of this video is to demonstrate the feasibility of SLN biopsy utilizing the SIRS platform and near infrared imaging in EC.

The patient was a 67 year old with FIGO grade I endometrial adenocarcinoma. Body mass index was 23.6 kg/m2 and the uterus was 10 cm on bimanual exam. Two milliliters of ICG was diluted to 1.25 mg/mL and was injected into the cervical stroma. The patient underwent pelvic washings, SLN biopsy, and extra fascial hysterectomy utilizing the daVinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) through a single multichannel port inserted through a 2.5 cm umbilical incision.

SLNs were mapped bilaterally to the hypogastric lymph node chains.Total operative time was 88 min and estimated blood loss was 50 mL. The patient was discharged home from the recovery room and no postoperative complications were noted. Swapping instruments to keep graspers on the medial aspect of the field improved visualization and minimized instrument clash while utilizing a vertical pexy of the vaginal cuff allowed for a more rapid cuff closure.

SLN biopsy and hysterectomy utilizing the SIRS are feasible and may offer some benefits over traditional robotic surgery. However, patients need to be carefully selected to minimize the risk of requiring complete lymphadenectomy and injury due to poor visualization.