Available online 1 May 2023

To show dissection of sentinel lymph nodes.

Step by step demonstration of the technique with narration.

Endometrial cancer (EC) is the most common gynecological malignancy throughout the world. Sentinel lymph node biopsy with indocyanine green (ICG) has become more widely used and has been featured in recently published guidelines for EC.1

Minimally invasive approaches with the sentinel lymph node concept (conventional laparoscopy, laparoscopic-assisted vaginal surgeries or robotic) to EC staging have resulted in lower rates of peri- and post-operative complications than conventional staging procedures.2

Yet no video article has been published in the literature about high pelvic, para-aortic sentinel lymph node dissection. Informed consent form was obtained from the patient. IRB approval was not required. A 45-year-old female with gravidity 0, parity 0, and body mass index 23.4 kg/m2 Presented with complaints of abnormal uterine bleeding (spotting). Increased endometrial thickness was detected on transvaginal ultrasound (10 mm) in the postmenstrual period. Endometrioid type endometrial adenocancer with focal squamous differentiation International Federation of Gynecology and Obstetrics (FIGO) grade 1 was detected on endometrial biopsy. The patient had hepatitis B virus positivity and no other chronic disease. A laparotomic myomectomy had been performed in 2016. Laparoscopic high pelvic, low para-aortic sentinel lymph node dissection with indocyanine green (ICG), hysterectomy (without uterine manipulator) + bilateral salpingo-oophorectomy were performed (video). The operation time for the procedure was 110 minutes and the estimated blood loss was less than 20mL.

No major complications occurred during or after the surgery. The patient stayed in hospital for 1 day. The final pathology result showed a FIGO grade 1, endometrioid type endometrial adenocancer with focal squamous differentiation, as a 1.5×1 cm tumorous mass invading less than one-half of the myometrium. Neither lymphovascular invasion nor sentinel lymph node metastasis was detected. A multicenter, prospective study showed that sentinel lymph node dissection with ICG in clinical stage 1 endometrial cancer is feasible and has a high degree of diagnostic accuracy in detecting endometrial cancer metastases. In that study, isolated para-aortic sentinel lymph node was detected in 3 of 340 patients (<1%)2 . Another study reported the detection rate of isolated para-aortic sentinel lymph node to be 1.1% in intermediate- and high- risk endometrial cancer patients.3

There are in some cases two distinct channels emanating from a side and that it is important to follow each and to acknowledge there may be more than one sentinels which are one lower in a typical location, and one higher as in this case. This video article is the first video demonstration of bilateral isolated high pelvic, para-aortic sentinel lymph node dissection in endometrial cancer.

© 2023 Published by Elsevier Inc. on behalf of AAGL.