Article Text
Abstract
Introduction Pelvic and para-aortic lymphadenectomy is part of surgical staging in apparent early-stage epithelial ovarian cancer. Even if some studies are evaluating sentinel lymph node (SLN) mapping as alternative of standard procedure, reported data are still heterogenous and limited and forward studies are necessaries. The aim of this video is to show our technique of retroperitoneal robotic-assisted SLN dissection in young patient with diagnosis of ovarian cancer.
Description Our patient is a 42-year-old woman with diagnosis of a malignant transformation of a dermoid cyst into an ‘intestinal-type’ mucinous adenocarcinoma, presumed FIGO stage IA (after right adnexectomy and complete peritoneal staging). Tumor board suggested surgical re-staging with pelvic and para-aortic lymphadenectomy that would allow, if negative, fertility-sparing surgery. We injected 2 mL of dilute indocyanine green solution into the right infundibulopelvic ligament. SLN were identified using fluorescence-guided dissection. Twenty minutes later, we identified an inter-aortocaval SLN, a pre-aortic SLN and a pre-inferior mesenteric artery SLN. SLN were extracted using endobag and sent to final pathology for ultra-staging. Complete pelvic and para-aortic lymphadenectomy was performed with standard robotic retroperitoneal approach. All lymph nodes were negative, included SLN, therefore surgical re-staging confirmed IA FIGO stage. There was no surgical complication.
Conclusion/Implications Retroperitoneal robotic-assisted approach for lymphadenectomy in early-stage ovarian cancer seems to be feasible with several advantages, avoids intra-peritoneal adhesions due to previous surgery and allows rapid post-surgery recovery and early access to adjuvant treatment. SLN seems feasible using this surgical approach allowing a high-precision dissection. Therefore, further studies are needed to validate this technique.