Introduction/Background ICG (Indocyanine Green) and robotic surgery have, in recent years, become an important part in oncoogynaecological surgery. Sentinel node detection (SLN) in endometrial cancer is unfortunetelly still subject of experimental research. Intermediate risk endometrial cancer (IR-EEC - myometrial invasion >50% or G3 and invasion <50%) and surgery management with or without systematic lymphadenectomy is also controversal. Combination of fluorometric SLN mapping using ICG and robotic system appears to be an attractive alternative to reliable staging.
Methodology We have, at our department, enrolled suitable patients for robotic surgery. All cases had diagnosis of IR-EEC established on histology and an oncogynecological ultrasound. Methodology was approved by ethical committe and informed consents were signed. We used of Memorial Sloan Kettering Cancer Center SLN algorithm: 4 ml of ICG (Verdye Diagnostic Green GmbH, Aschheim,Germany) was applied, divided into two injection at 3 and 9 o´clock position of the cervix, with 1 ml in the stroma and 1 ml submucosally. After docking of robotic system daVinci X (Intuitive Surgical Inc., Sunnyvale, CA) we started procedure with opening of retroperitoneal spaces. So called Firefly mode on robotic console - Near Infrared Fluroscence was applied. Detected SLNs were removed and completelly examined with ultra and immunohistochemistry microstaging SLN protocol. Surgery was completed with hysterectomy type B and bilateral salpingo-oophorectomy.
Results During our starting period, 9 cases were managed. SLN was detected in all patients (9/9), detection rate is100%. In 8 patients (89%) the detection was bilaterally in pelvis. In 2 cases (22%) were SLN visible also in paraaortic region. Alltogether 24 lymph nodes were examined. None of the examined SLNs (0%) contained micrometastases or isolated tumor cells.
Conclusion Combining the easily applied ICG dye with technical options of robotic system for intraoperative visualization has the potential to replace currently established surgical techniques and can reduce postoperative patients morbidity.
Disclosure Nothing to disclose.
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