Robotic Sentinel Lymph Node Mapping Research Articles

Recurrence patterns and survival in patients with endometrial cancer undergoing robotic sentinel lymph node mapping (SLNM)

Objective: To assess recurrence-free survival (RFS) and overall survival (OS), and to analyze patterns of disease recurrence in patients with apparent uterine-confined endometrial cancer (EC) who underwent robotic sentinel lymph node mapping (SLNM) followed by hysterectomy with or without completion lymphadenectomy.

Paraaortic lymph node dissection pathology in patients with endometrial cancer undergoing robotic sentinel lymph node mapping (SLNM)

Objective: To describe paraaortic and pelvic lymph node pathology in patients with apparent uterine-confined endometrial cancer who underwent robotic hysterectomy with sentinel lymph node mapping (SLNM) and completion pelvic and paraaortic lymphadenectomy (LN).

Laparoscopic Sentinel Lymph Node Mapping with Indocyanine Green Using the iSpies Platform: Initial Experience Argentina

Study ObjectiveTo demonstrate the initial experience in Argentina using the iSpies indocyanine green (ICG) platform in sentinel lymph node mapping in patients with early-stage cervical cancer. DesignStep-by-step demonstration of the technique using a video and pictures (educative video) (Canadian Task Force classification III). SettingLaparoscopic and robotic sentinel lymph node mapping using ICG has been shown to be safe and feasible; however, in developing countries, the opportunities to use fluorescent imaging through a minimally invasive approach are very limited, given the cost restrictions of acquiring the near-infrared technology and the fluorescent dyes. InterventionA 47-year-old woman presented with a stage IB1 squamous cervical cancer. Physical examination revealed a 1.5-cm tumor without evidence of parametrial involvement. Magnetic resonance imaging did not show any evidence of metastatic disease. The patient underwent laparoscopic radical hysterectomy with sentinel lymph node mapping. On laparoscopic exposure of the pelvic spaces, a cervical injection of ICG (1 mL superficial and deep) was administered using a spinal needle at the 3 o'clock and 9 o'clock positions. Sentinel lymph node mapping was then performed using the ICG (Pulsion Medical Systems, Feldkirchen, Germany) and an iSpies near-infrared camera (Karl Storz Endoskope, Tuttlingen, Germany). Bilateral sentinel lymph nodes were detected on the left external iliac artery and in the right obturator space. Both were confirmed ex vivo. The total operative time was 170 minutes. No intraoperative or postoperative complications were reported, and the patient was discharged at 48 hours after surgery. Estimated blood loss was minimal. Sentinel lymph node mapping alone is not the standard of care in our institution, and thus bilateral lymphadenectomy was performed. Ultrastaging is routinely performed when a sentinel lymph node is evaluated. Final pathology revealed a tumor confined to the cervix, with tumor-free margins, and a total of 10 lymph nodes that were negative for any evidence of disease. Disadvantages of this technology compared with the Pinpoint ICG system (Novadaq Technologies; Bonita Springs, FL) is the lack of simultaneous white vision and fluorescence ICG detection, and the to manually change normal vision to infrared vision. An advantage of the Storz iSpies system is its availability in our country, considering that the technology developed by Novadaq is not yet approved in Argentina. ConclusionAlthough ICG sentinel lymph node mapping is becoming a standard of care [1,2], a lack of ICG dye or laparoscopic near-infrared technologies could be a deterrent to its use in developing countries. A focus on expanding this technology in countries with limited resources would allow patients the opportunity to avoid the morbidity associated with full lymphadenectomy.

Is it time to consider the sentinel lymph node mapping the new standard in endometrial cancer

In the march issue of Lancet Oncology , Rossi et al . published the results of a prospective multicenter validation trail on robotic indocyanine green (ICG) sentinel lymph node (SLN) mapping in endometrial cancer (EC): the FIRES trial (1). In this trial, at 18 institutions, 340 patients with EC underwent a robotic ICG SLN mapping followed by a systematic pelvic lymph node dissection in every case and by a para-aortic lymph node dissection in 58% of the cases. The median number of SLNs and of total nodes removed was 2 and 19 respectively. We believe that this is a landmark trial that may lead to changes in the management recommendations for EC. The prospective multicentre design and the strong validation data derived from its large cohort of patients and the thoroughness of the lymphadenectomy represent its major strengths.