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Video-endoscopic inguinal sentinel lymph node biopsy with indocyanine green in vulvar cancer
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  1. Filippo Maria Capomacchia1,2,
  2. Nicolò Bizzarri1,
  3. Aniello Foresta1,2,
  4. Simona Fragomeni1,
  5. Giorgia Garganese1,2,
  6. Giovanni Scambia1,2 and
  7. Angelica Naldini1
    1. 1UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
    2. 2Università Cattolica del Sacro Cuore, Rome, Italy
    1. Correspondence to Dr Nicolò Bizzarri, Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; nicolo.bizzarri{at}yahoo.com

    https://doi.org/10.1136/ijgc-2024-005887

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      The standard surgical treatment for vulvar carcinoma <4 cm in size without clinical or radiological suspicion of lymph node metastases consists of resection of the vulvar tumor with sentinel lymph node (SLN) biopsy.1 The standard approach to inguinal lymph node staging is associated with a high rate of post-operative complications such as wound dehiscence, lymphocele, lymphedema, infections, hematoma, cellulitis, and hernia formation.2 The feasibility of video-endoscopic inguinal lymphadenectomy has been shown in a previous study, allowing a systematic removal of inguinal lymph nodes with lower morbidity.3

      The aim of Video 1 is to report the surgical technique of video-endoscopic inguinal SLN biopsy with indocyanine green in vulvar cancer.

      Video 1 Inguinal sentinel lymph node biopsy with indocyanine green in vulvar cancer

      We present the case of an 83-year-old patient with 2 cm central anterior vulvar squamous cell carcinoma. SLN biopsy was performed by the video-endoscopic approach using indocyanine green (ICG)4 and technetium-99m (injected the day before). After placement of a 12 mm trocar for the camera and two ancillary 5 mm trocars, the procedure was performed by blunt dissection up to the inguinal ligament. The SLN was visualized with a near-infrared camera and then resected. A gamma probe confirmed the concordance between ICG and technetium-99m in the identification of SLNs.

      Video 1 shows the anatomical landmarks and the surgical technique of video-endoscopic inguinal SLN biopsy in a patient with vulvar cancer. The concordance between ICG and technetium-99m makes ICG a promising tool for further studies on ICG as a single tracer.

      Data availability statement

      All data relevant to the study are included in the article or uploaded as supplementary information.

      Ethics statements

      Patient consent for publication

      Ethics approval

      This study involves human participants but IRB approval was not required. Participants gave informed consent to participate in the study before taking part.

      Acknowledgments

      We would like to express our sincere gratitude to Dr. Chiara Caricato for contributing to the creation of this video by lending her voice for the narration.

      References

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        1. Oonk MHM,
        2. Planchamp F,
        3. Baldwin P, et al
        . European Society of Gynaecological Oncology guidelines for the management of patients with vulvar cancer - update 2023. Int J Gynecol Cancer 2023;33:1023–43. doi:10.1136/ijgc-2023-004486
        OpenUrlAbstract/FREE Full Text
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        1. Wills A,
        2. Obermair A
        . A review of complications associated with the surgical treatment of vulvar cancer. Gynecol Oncol 2013;131:467–79. doi:10.1016/j.ygyno.2013.07.082
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      3. ↵
        1. Naldini A,
        2. Rossitto C,
        3. Pacelli F, et al
        . The video endoscopy inguinal lymphadenectomy for vulvar cancer: a pilot study. Taiwan J Obstet Gynecol 2017;56:281–5. doi:10.1016/j.tjog.2017.04.003
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        1. Koual M,
        2. Benoit L,
        3. Nguyen-Xuan HT, et al
        . Diagnostic value of indocyanine green fluorescence guided sentinel lymph node biopsy in vulvar cancer: a systematic review. Gynecol Oncol 2021;161:436–41. doi:10.1016/j.ygyno.2021.01.031
        OpenUrl

      Footnotes

      • FMC and NB are joint first authors.

      • FMC and NB contributed equally.

      • Contributors FMC: Conceptualization, video editing, writing original draft. NB: Conceptualization, writing original draft, supervision, guarantor. AF: Video editing, writing original draft. SF: Conceptualization, writing review. GG: Conceptualization, writing review. GS: Conceptualization, project administration, supervision. AN: Conceptualization, project administration, surgery and video recording, supervision, writing review.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.