Introduction By the recent inclusion of sentinel lymph node (SLN) technique in lymph node staging of high-risk subtypes of early-stage endometrial cancer, a cleaned-up technique of sentinel node is needed. One of the most relevant prospective studies about validation of the sentinel lymph node technique in high-risk endometrial cancer, SENTOR trial by Cusimano et al. describes an overall detection rate of 97.4% with the use of Indocyanine green as the sole tracer. It is essential to be systematic and meticulous in sentinel lymph node detection with the inspection of main retroperitoneal pelvic spaces without ignoring the presacral region. As recommended by ESGO quality standards, this surgery must be performed by gynecological oncologist surgeons.
Methods This video has been edited based on surgeries performed in our department in patients with early stage endometrial cancer following the surgical algorithm established for the detection of SLN.
Results Surgical technique video of bilateral pelvic sentinel node biopsy in high-risk endometrial cancer is presented. The aim of this video is to highlight the importance of step-by-step (five steps) technique in order to achieve and accurate technique improving bilateral detection rate and decreasing false negative rate in these cases.1. Cervical injection technique of ICG.2. Inspection of main lymphatic pathways of drainage.3. Opening retroperitoneal spaces with a meticulous SLN dissection.4. Identification of echelon lymph nodes.5. Safe extraction of sentinel lymph nodes.
Conclusions With the inclusion of SLN biopsy like an alternative of systematic lymph node dissection in high-risk endometrial cancer, a systematic surgical technique is important in order to achieve the best accuracy of the technique. Moreover, the best detection rates are achieved in experienced hands with the use of ICG and careful inspection of retroperitoneal spaces (including presacral space).
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