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943 Vaginal endoscopy for sentinel lymph node detection in gynaecological oncology: a comparison of detection rate with common laparoscopic approach
  1. Janire Zarragoitia,
  2. Francesc Fargas,
  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. Taking advantage of these improvements, we have started to study and perform sentinel lymph node (SLN) detection via vNOTES, being able to achieve the same detection rate as described in previous literature via laparoscopic surgeries.

Methodology For the lymph node detection, we use either ICG or a combination of ICG and 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 contrast provided by the ICG and the reduced background sound artifacts for the Tc99 detection.

Results 26 patients underwent bilateral SLNB, using ICG +/- Tc99 as tracers. 17 patients (65.4%) had ICG+Tc99 injection and 9 patients (34.6%) had just ICG injection. 6 patients among the combined tracer injection had no migration of Tc99 (35.3%), and only in one case we had lack of ICG migration unilaterally (3.8%).

Overall, all intraoperative pathological study of the sentinel nodes were negative except for one cervical cancer patient with positive macroscopic affected SN, in which the planned surgery was stopped and a retroperitoneal paraaortic lymphadenectomy was performed following protocol.

Conclusion This analysis of the study suggests that vNOTES could be a safe approach to perform oncological procedures in early-stage cancers, including the SLNB assessment. The proven advantages to this technique are shorter intraoperative time, better recovery and faster hospital discharge thanks to a minimum manipulation of the pelvic peritoneum, lack of need of uterine manipulator, and better and closer visualization of the operating site, with similar detection rates of the SNLB as the laparoscopic approach.

Disclosures None.

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