Retroperitoneal Sentinel Lymph Node Dissection Using vNOTES in Early-Stage Cervical Cancer: A Case Report

To demonstrate retroperitoneal sentinel lymph node dissection for early-stage cervical cancer using vaginal natural orifice transluminal endoscopic surgery (vNOTES).

Lymph node status plays a central role in staging and treatment planning in cervical cancer [1]. In early-stage disease, confirmation of nodal involvement may alter management from primary surgery to chemoradiotherapy [2]. Sentinel lymph node biopsy has emerged as a minimally invasive and reliable method for nodal assessment [3]. This video article demonstrates retroperitoneal sentinel lymph node dissection via vNOTES in 7 surgical steps.

About 56-year-old woman with cervical adenocarcinoma INTERVENTIONS: We present the case of a 56-year-old woman with cervical adenocarcinoma and a radiologically suspicious left pelvic lymph node measuring approximately 1 cm on preoperative magnetic resonance imaging. Because suspected nodal involvement would directly influence treatment planning, sentinel lymph node sampling was performed before definitive surgery. To improve orientation for viewers, the text includes a literal drawing of the pelvic retroperitoneal pathway and the expected location of the sentinel lymph node, together with expanded narration emphasizing key anatomic landmarks and dissection steps (Fig. 1). Although indocyanine green may provide higher detection rates, isosulfan blue was used because indocyanine green was not available at our institution. A total of 2 mL of undiluted isosulfan blue was injected into the cervix at the 3 and 9 o'clock positions, with 0.5 mL injected superficially and 0.5 mL deeply at each site. The procedure consisted of: (1) cervical blue dye injection; (2) entry into the retroperitoneal space through the lateral vaginal fornix; (3) retroperitoneal dissection; (4) identification of anatomic landmarks; (5) detection of the sentinel lymph node; (6) obturator fossa dissection; and (7) sentinel lymph node excision.

Retroperitoneal sentinel lymph node dissection using vNOTES appears feasible as a minimally invasive approach for nodal assessment in selected patients with early-stage cervical cancer and may support individualized treatment planning while avoiding abdominal access. VIDEO ABSTRACT.