vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective...

Area of Science:

• Gynecologic Oncology
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Endometrial cancer staging typically involves laparoscopic hysterectomy with bilateral sentinel node resection.
• Retroperitoneal vNOTES (vaginal Natural Orifice Transluminal Endoscopic Surgery) offers potential benefits like reduced invasiveness, no visible scars, and improved ventilation for obese patients.
• This approach may also follow natural lymph node pathways, potentially reducing the risk of missed sentinel nodes.

Purpose of the Study:

• To evaluate the feasibility of a retroperitoneal vNOTES approach for sentinel lymph node dissection in staging early-stage endometrial cancer.

Main Methods:

• A prospective multicenter case series involving 64 women with early-stage endometrial carcinoma.
• Sentinel lymph nodes were accessed and removed via a transvaginal retroperitoneal vNOTES approach using indocyanine green and near-infrared light for identification.
• All patients subsequently underwent vNOTES hysterectomy and bilateral salpingo-oophorectomy.

Main Results:

• Bilateral sentinel nodes were identified in 97% of the 64 patients.
• The median operative time was 126 minutes with a median estimated blood loss of 80 mL.
• No complications with sequelae were reported; 60 patients had negative nodes, three had isolated tumor cells, and one had macroscopically positive nodes.

Conclusions:

• The retroperitoneal vNOTES approach is a feasible and safe method for sentinel lymph node identification and removal in endometrial cancer staging.
• This technique provides sole transvaginal access to the retroperitoneal space, following natural lymph trajectories without requiring a Trendelenburg position.