vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series
Abstract Introduction The current standard treatment for endometrial cancer is a laparoscopic hysterectomy with adnexectomies and bilateral sentinel node resection. A retroperitoneal vNOTES sentinel node resection has several theoretical potential advantages. These include being less invasive, leavi...
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Wiley
2024-07-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14843 |
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| author | Jan Baekelandt Astrid Jespers Daniela Huber Levon Badiglian‐Filho Andrea Stuart Linus Chuang Oudai Ali Alexander Burnett |
| author_facet | Jan Baekelandt Astrid Jespers Daniela Huber Levon Badiglian‐Filho Andrea Stuart Linus Chuang Oudai Ali Alexander Burnett |
| author_sort | Jan Baekelandt |
| collection | DOAJ |
| description | Abstract Introduction The current standard treatment for endometrial cancer is a laparoscopic hysterectomy with adnexectomies and bilateral sentinel node resection. A retroperitoneal vNOTES sentinel node resection has several theoretical potential advantages. These include being less invasive, leaving no visible scars, operating without Trendelenburg, and therefore offering the anesthetic advantage of easier ventilation in obese patients and following the natural lymph node trajectory from caudally to cranially and therefore a lower risk of missing the sentinel node. The aim of this study is to determine the feasibility of a retroperitoneal vNOTES approach to sentinel lymph node dissection for staging of endometrial cancer. Material and methods A prospective multicenter case series was performed in four hospitals. A total of 64 women with early‐stage endometrial carcinoma suitable for surgical staging with sentinel lymph node removal were operated via a transvaginal retroperitoneal vNOTES approach. The paravesical space was entered through a vaginal incision after injecting the cervix with indocyanine green. A vNOTES port was placed into this space and insufflation of the retroperitoneum was performed. Sentinel lymph nodes were identified bilaterally using near‐infrared light followed by endoscopic removal of these nodes. Results A total of 64 women with early‐stage endometrial cancer underwent sentinel lymph node removal by retroperitoneal vNOTES technique. All patients also underwent subsequent vNOTES hysterectomy and bilateral salpingo‐oophorectomy. The median age was 69.5 years, median total operative time was 126 min and the median estimated blood loss was 80 mL. In 97% of the cases bilateral sentinel nodes could be identified. A total of 60 patients had negative sentinel nodes, three had isolated tumor cells and one had macroscopically positive sentinel nodes. No complications with sequel occurred. Conclusions This prospective multicenter case series demonstrates the feasibility of the vNOTES approach for identifying and removing sentinel lymph nodes in women with endometrial carcinoma successfully and safely. vNOTES allows sole transvaginal access with exposure of the entire retroperitoneal space, following the natural lymph trajectory caudally to cranially, and without the need for a Trendelenburg position. |
| format | Article |
| id | doaj-art-5d9cc6e9a8de497f85594b312ccf8fde |
| institution | DOAJ |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-5d9cc6e9a8de497f85594b312ccf8fde2025-08-20T03:22:14ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122024-07-0110371311131710.1111/aogs.14843vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case seriesJan Baekelandt0Astrid Jespers1Daniela Huber2Levon Badiglian‐Filho3Andrea Stuart4Linus Chuang5Oudai Ali6Alexander Burnett7Department of Gynecology Imelda Hospital Bonheiden BelgiumDepartment of Gynecology Imelda Hospital Bonheiden BelgiumDepartment of Obstetrics and Gynecology Sion Hospital Sion SwitzerlandDepartment of Gynecologic Oncology AC Camargo Cancer Center Sao Paulo BrazilDepartment of Obstetrics and Gynecology, Institute for Clinical Sciences Lund University Lund SwedenDepartment of Gynecologic Oncology, Nuvance Health, Larner College of Medicine University of Vermont Burlington Vermont USADepartment of Gynecology Epsom and St Helier University London UKDepartment of Obstetrics and Gynecology, Division of Gynecologic Oncology University of Arkansas for Medical Sciences Little Rock Arkansas USAAbstract Introduction The current standard treatment for endometrial cancer is a laparoscopic hysterectomy with adnexectomies and bilateral sentinel node resection. A retroperitoneal vNOTES sentinel node resection has several theoretical potential advantages. These include being less invasive, leaving no visible scars, operating without Trendelenburg, and therefore offering the anesthetic advantage of easier ventilation in obese patients and following the natural lymph node trajectory from caudally to cranially and therefore a lower risk of missing the sentinel node. The aim of this study is to determine the feasibility of a retroperitoneal vNOTES approach to sentinel lymph node dissection for staging of endometrial cancer. Material and methods A prospective multicenter case series was performed in four hospitals. A total of 64 women with early‐stage endometrial carcinoma suitable for surgical staging with sentinel lymph node removal were operated via a transvaginal retroperitoneal vNOTES approach. The paravesical space was entered through a vaginal incision after injecting the cervix with indocyanine green. A vNOTES port was placed into this space and insufflation of the retroperitoneum was performed. Sentinel lymph nodes were identified bilaterally using near‐infrared light followed by endoscopic removal of these nodes. Results A total of 64 women with early‐stage endometrial cancer underwent sentinel lymph node removal by retroperitoneal vNOTES technique. All patients also underwent subsequent vNOTES hysterectomy and bilateral salpingo‐oophorectomy. The median age was 69.5 years, median total operative time was 126 min and the median estimated blood loss was 80 mL. In 97% of the cases bilateral sentinel nodes could be identified. A total of 60 patients had negative sentinel nodes, three had isolated tumor cells and one had macroscopically positive sentinel nodes. No complications with sequel occurred. Conclusions This prospective multicenter case series demonstrates the feasibility of the vNOTES approach for identifying and removing sentinel lymph nodes in women with endometrial carcinoma successfully and safely. vNOTES allows sole transvaginal access with exposure of the entire retroperitoneal space, following the natural lymph trajectory caudally to cranially, and without the need for a Trendelenburg position.https://doi.org/10.1111/aogs.14843endometrial cancerlymph nodesretroperitoneal dissectionsentinelstagingvNOTES |
| spellingShingle | Jan Baekelandt Astrid Jespers Daniela Huber Levon Badiglian‐Filho Andrea Stuart Linus Chuang Oudai Ali Alexander Burnett vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series Acta Obstetricia et Gynecologica Scandinavica endometrial cancer lymph nodes retroperitoneal dissection sentinel staging vNOTES |
| title | vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series |
| title_full | vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series |
| title_fullStr | vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series |
| title_full_unstemmed | vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series |
| title_short | vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series |
| title_sort | vnotes retroperitoneal sentinel lymph node dissection for endometrial cancer staging first multicenter prospective case series |
| topic | endometrial cancer lymph nodes retroperitoneal dissection sentinel staging vNOTES |
| url | https://doi.org/10.1111/aogs.14843 |
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