Application of Sentinel Lymph Node Technique to Transvaginal Natural Orifices Transluminal Endoscopic Surgery (NOTES) in Endometrial Cancer.

OBJECTIVE: This report outlines our first experience of SLN mapping in NOTES technique which is the combination of the least invasive surgical approach and the least invasive way of assessing lymph node status.

DESIGN: Descriptive study (Canadian Task Force Classification III) SETTING: Tertiary referral and educational center.

PATIENTS: A total of 4 patients with endometrial cancer clinical stage1.

INTERVENTIONS: NOTES with SLN mapping using indocyanine green (ICG)-based near-infrared fluorescence imaging technique.

MEASUREMENTS AND MAIN RESULTS: The average operative time was 182.75 (SD,34.5) minutes. Mean estimated blood loss was 67.5 (SD39.4) ml. All of them had surgical staging of FIGO IA (pT1aN0). The overall detection rate and bilateral detection rate were 100% (4 of 4). All procedures were successfully completed without complication or conversion to conventional laparoscopy.

CONCLUSION: In our preliminary experience, SLN mapping in NOTES surgery appears to be feasible and safe. It can be considered as an alternative method to reduce morbidity from radical lymphadenectomy and provide the benefits from NOTES technique. However, the studies in the larger population are necessary.