Introduction/Background Sentinel lymph node (SLN) mapping has recently been introduced into many Gynaecological Oncology Consensus Recommendations in an effort to secure information concerning lymph node status for treatment planning and in order to have information about prognosis, yet minimise collateral damage if complete lymphadenectomy can be avoided.
The aim of this video is to present ara-aortic and pelvic SLN detection using a Dual Tracer: radiolabeled colloid Technetium 99 (Tc99) and Indocyanine green (ICG), and Dual Injection (cervical and fundal).
Methodology In this video we present one of our case-series (61 year-old woman diagnosed with initial stage IAG3 endometrial adenocarcinoma). The day before the intervention a dual Tc 99 injection was performed:
1) cervical injection: 2 ml at 3 o-clock and another 2 ml at 9 o’clock at only 0.5 cm intracervical depth;
2) Intramiometrial fundal injection: 4 ml (1 cm deep), under ultrasonographic vision. Intraoperative dual injection: first, the fundal ICG injection (2 ml at 1 cm depth) was performed under laparoscopic vision; and then the cervical injection
(1 ml at 3 o’clock and another 1 ml at 9 o´clock (0.5 cm deep)
Results In this case detection is seen in 2 para-aortic SLN and 2 bilateral pelvic SLN nodes. The most interesting thing about this video is to observe that ICG uptake correlates perfectly with the sound capture of the laparoscopic nuclear probe.
Conclusion This video shows para-aortic and pelvic dual uptake and the concordance using two tracers. A dual tracer could help in the ICG learning curve and ensure that the right SLN is removed. Dual injection could increase para-aortic SLN detection using a simple, safe, reproducible technique.
Disclosure Nothing to disclose
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