Introduction/Background Vaginal Transluminal Endoscopic Surgery is frequently used in the field of gynecologic oncology. The procedure, so-called scarless surgery, enables surgeons to manage especially morbidly obese patients. Regional anesthesia used for this procedure may be regarded as the biggest advantage for fragile cancer patients. Sentinel lymph node mapping for endometrial cancer, which is less radical surgery with more precise staging accuracy, can be integrated with V-NOTES surgery in endometrial cancer.

A 61-year-old patient was admitted to our hospital with postmenopausal bleeding. Endometrial biopsy revealed endometrioid adenocarcinoma grade 1. A 3 cm in diameter endometrial tumor was detected during the ultrasound examination. PET CT showed no distant metastasis.

Methodology The patient was prepared in the dorsal lithotomy position. Spinal anesthesia was performed. Lateral vaginal wall incisions were made to enter the retroperitoneum. The incisions in the vaginal wall were about 5 cm in length. After mucosal incisions were made, deeper dissections were performed using scissors until pelvic muscles were reached. An Alexis retractor with a 7 cm diameter was introduced to the incisions. A gel point was attached to the Alexis retractor. A 10 mm and two 5 mm cannulas were inserted into the gel point. Pneumoperitoneum was provided. Cranial dissections following avascular spaces were performed. Obturator muscles were determined, and obturator arteries, veins, and nerves were identified. External iliac vessels were followed, and the bifurcation of internal and external iliac arteries was reached. Bilateral sentinel lymph nodes were detected using overlay mode and removed vaginally. The vaginal incisions were closed with interrupted sutures. Then V-NOTES hysterectomy and bilateral salpingo-oophorectomy were performed.

Results The patient was discharged on the postoperative 2nd day without any complications. Ultrastaging lymph node evaluation revealed no metastasis.

Conclusion V-NOTES sentinel lymph mapping for endometrial cancer is a feasible surgical route, in addition to the advantage of regional anesthesia.

Disclosures In the current video, we present an endometrial cancer patient who was managed by V-NOTES sentinel lymph node mapping and V-NOTES hysterectomy and salpingo-oophorectomy.

V-NOTES: Natural Orifice Transluminal Endoscopic Surgery.