Introduction Pelvic sentinel lymph node (SLN) in initial stage endometrial cancer may result in higher rates of bilateral detection after a combination of radiotracer and blue dye. In this video we demonstrate a standardized and reproducible laparoscopic standard SLN technique, with permanent instruments, completely performed by surgeons in training.
Methods A 69 years old patient presented a uterine Stage IA G2 endometrioid adenocarcinoma. Less than 50% myometrial invasion was observed at preoperative MRI. At board review, a minimally invasive class A hysterectomy with bilateral salpingoophorectomy and SLN was indicated. Technetium-99 was injected into the cervix the day before surgery, and scintigraphy confirmed bilateral pelvic nodes (external iliac on the right side and interiliac on the left side). At the operating room, patent blue (2cc in 2cc of saline), was injected at 3 and 9 o’clock in the cervix, just after throcar insertion.
Results This video demonstrates a standard step-by-step laparoscopic SLN using double detection technique and permanent instruments. Pelvic lateral spaces dissection was important to identify all marked nodes. There were 2 blue nodes in each pelvic side: obturator/interiliac and external iliac. All 4 were positive in ex-vivo gamma-probe assessment. After the procedure, there were no other sites of gamma-probe detection.
Conclusion SLN detection with combined blue dye and radiotracer may result in an adequate bilateral pelvic detection in early stage endometrial cancer. This standard technique may require only permanent laparoscopic instruments, representing less costs and high reproductibility.
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