Article Text
Abstract
Introduction Lymph node assessment by sentinel lymph node (SLN) sampling has important prognostic and therapuetic roles in endometrial cancer (EC). While the majority of SLNs are typically located in the obturator and external iliac regions, the absence of positive staining necessitates exploration of less common sites, such as the presacral and paraaortic areas. Hence, a methodical step-by-step approach is indispensable for effectively identifying SLNs, thereby guiding subsequent management decisions for these patients.
Description This video presents our team’s robotic technique for SLN in EC using a step-by-step approach, in a 44-year-old woman who presented to our center with a grade 1 endometrioid EC. At the beginning of the surgery, a 1mg/ml of ICG was used to infiltrate the cervix at the 3 and 9 o’clock positions. Following exposure of the ureter, and development of the pararectal and paravesical spaces, the SLN was not detected requiring us to follow the lymphatic vessels along their path to the presacral area. After several minutes, the sentinel lymph was located to the presacral area, extracted, and sent to pathology for evaluation by ultra-staging.
Conclusion/Implications Employing systematic step-by-step protocol to locate SLN in patients with EC allows us to identify even those restricted to uncommon locations within a reasonable timeframe.