vNOTES retroperitoneal sentinel lymph node biopsy and pelvic lymph node dissection for surgical staging of...

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has shown favourable outcomes in benign gynaecology, but its oncological application remains underexplored. This study aimed to evaluate the technique, operative outcomes and oncological feasibility of vNOTES retroperitoneal sentinel lymph node biopsy (SLNB) and/or pelvic lymph node dissection (PLND) for endometrial cancer staging.

A retrospective review was conducted of consecutive patients who underwent vNOTES THBSO with SLNB and/or PLND for endometrial malignancy at Singapore General Hospital between August 2023 and August 2024. Demographic, peri-operative and postoperative outcomes were analysed.

19 patients were included, with a median age of 59 years [IQR 56.5-70.7] and median BMI 25.2 kg/m² [IQR 21.5-27.5]. Pre-operative histology showed endometrioid adenocarcinoma in 14 (73.7 %), atypical endometrial hyperplasia in two (10.5 %) and other subtypes in three (15.8 %). Three (15.8 %) underwent SLNB only, 13 (68.4 %) PLND and three (15.8 %) both. Median operative time was 190 min [IQR 178-203] and blood loss 200 mL [IQR 100-200]. Sentinel nodes were identified bilaterally in five of six mapped patients, all negative for metastasis. Median lymph node yield for PLND was 11.5, with metastasis in two patients (10.5 %). 74 % of patients were discharged by postoperative day two. Final histopathology showed Stage I in 11 (57.9 %), Stage II in five (26.3 %) and Stage III in three (15.8 %). Over a median follow-up of 10.6 months, one patient who declined adjuvant therapy developed recurrence.

vNOTES SLNB and PLND are feasible, safe, and effective for endometrial cancer staging in selected patients.