Introduction/Background Bilateral pelvic lymphadenectomy in early stage endometrial cancer my result in significant lymphedema. Efforts have been made to reduce the extent of nodal dissection to minimize lymphedema by the application of sentinel lymph node (SNL) mapping with success.
Methodology A 25 mg single vial of ICG was used at each surgery. ICG was diluted with 20 ml of normal saline. A 4 ml. of the prepared solution was injected into the uterine cervical stroma at 4 and 8 o'clock positions to lessen the staining of the anterior vesical-uterine space. ICG was placed submucosally and in the deep layer of the uterine cervical stroma. Following that A Vcare uterine manipulator is placed vaginally. A veress needle is placed in the umbilicus for peritoneal insufflation. A 2 cm incision over the lower rim of the umbilicus was performed. The patient was placed in Trendelenburg position, and the DaVinci XI robotic surgical system is side-docked parallel to the right side of the patient. The retroperitoneum space is explored. The green stained channels were looked for in the parametrium crossing over the superior vesical artery and presacral spaces and followed to any green stained SLN. The green stained SLN’s are resected and excised. If non green stanning is identified, a complete bilateral lymphadenectomy is performed. In addition, total hysterectomy and bilateral salpingo-oophrectomy are performed in both cases. Abdominal incisions are closed with O vicryl suture.
Results SLN was identified in 76% of patients. The operating time was maintained at 150 minutes, and console time 100 minutes. Estimated blood loss was 100 ml. Patients discharged home the following day.
Conclusion Farghaly's technique of robot assisted sentinel lymph node mapping utilizing Indocyanine green identifies more pelvic nodal metastasis than standard lymphadenectomy. It is feasible and has the advantage of decreasing morbidity, reducing risk of dissemination and short hospital stay.
Disclosure Nothing to disclose.
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