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940 Vaginal endoscopy for sentinel lymph node detection in gynaecological oncology: surgical techinique description
  1. Francesc Fargas,
  2. Janire Zarragoitia,
  3. Sonia Baulies,
  4. Francesc Tresserra and
  5. Rafael Fabregas
  1. Dexeus University Hospital, Barcelona, Spain


Introduction/Background It has been demonstrated that the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a feasible and adequate technique to treat benign gynecologic diseases, improving quality of life, blood loss, and postoperative pain.

Methodology This is a descriptive study of the surgical technique used to perform SNLB assessment via vNOTES in our center. For the SNL detection, we use ICG or a combination of ICG-Tc99. The advantage of the vaginal approach is that it allows us to see the pathway of the afferent lymphatic vessel from the cervix site of injection up until de lymph node thanks to the ICG and the reduced background sound artifacts for the Tc99 detection.

Results First, we perform a cervical closure suture or vaginal cuff closure for the prevention of tumor spillage from the external cervical orifice. After that we perform a 2cm oblique incision on one side (3–5h or 7–9h), proceeding with a digital dissection parallel to the iliac vessels until we reach the obturator foramen and continue the dissection of the pararectal space and pre-sacral fascia.

We then place the small Alexis, and start the pneumoperitoneum. By means of atraumatic short movements, we dissect the superior vesical artery, and the iliac vessels starting from the external iliac vein. The visualization of the ascending lymphatic vessel up until the sentinel node is usually very clear, and in case of using the double tracer (ICG+Tc99), we use the gamma probe to confirm it.

Once one side is done, we do the same procedure on the other side, and finally a hysterectomy with the big Alexis.

Conclusion This surgery is performed via natural orifices, meaning shorter intraoperative time, lack of manipulation of the pelvic peritoneum with faster and better recovery of the patient, no need for uterine manipulator, and better visualization of the afferent lymph vessels.

Disclosures None.

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