Sentinel Lymph Node Mapping by Retroperitoneal vNOTES for Uterus-Confined Malignancies: A Standardized 10-Step...

Area of Science:

• Gynecologic Oncology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Sentinel lymph node (SLN) mapping is crucial for staging endometrial and cervical cancers.
• Conventional laparoscopy is common, but a novel retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach is emerging.
• Current research on vNOTES SLN mapping is limited (IDEAL Stage 2a), necessitating standardization.

Purpose of the Study:

• To describe a standardized retroperitoneal pelvic SLN mapping technique using vNOTES.
• To provide a reproducible methodology for this minimally invasive approach.
• To facilitate further research and clinical adoption of vNOTES for gynecologic cancer staging.

Main Methods:

• Detailed description of a 10-step standardized retroperitoneal vNOTES procedure.
• Includes pre-operative, intra-operative, and post-operative management protocols.
• Focuses on visualization of lymphatic afferent vessels and pelvic lymph nodes.

Main Results:

• Successful implementation of a standardized 10-step retroperitoneal vNOTES SLN mapping approach.
• Demonstrates feasibility and provides a coherent mapping methodology.
• Establishes a foundation for future multi-center studies and clinical trials.

Conclusions:

• The described standardized approach aids surgeons in adopting retroperitoneal vNOTES SLN mapping.
• This methodology is essential for advancing research from IDEAL Stage 2a to Stage 2b (multi-center studies) and Stage 3 (RCTs).
• Standardization promotes surgical homogeneity, crucial for validating vNOTES in gynecologic cancer staging.