Robotic Sentinel Paraaortic Lymph Node Mapping in Endometrial Cancer

초록

Study Objective Cervical indocyanine green (ICG) injection is standard for sentinel lymph node (SLN) mapping in endometrial cancer but has limited ability to identify paraaortic SLNs. A two-step mapping strategy using both cervical and uterine cornu ICG injection has been proposed. This study demonstrates the first step of this approach?uterine cornu injection?using robotic surgery. Design Narrated surgical video. Setting Tertiary referral hospital. Patient A 39-year-old woman (G2P2) diagnosed with endometrioid adenocarcinoma after abnormal uterine bleeding. Imaging revealed a 2-cm lower uterine segment lesion without lymphadenopathy; tumor markers were within normal limits. Intervention Robotic surgical staging was performed using the da Vinci SP system, including hysterectomy, bilateral salpingectomy, and SLN biopsy. Diluted ICG (1.25 mg/mL) was injected into both uterine cornu, and lymphatic flow was visualized with Firefly imaging. The procedure included tracking paraaortic lymphatic drainage and SLN biopsy. Results Paraaortic SLNs were identified 8 minutes after injection, with lymphatic drainage along the ovarian vessels. Three SLNs were detected at the inframesenteric interaortocaval region from the right cornu and one at the inframesenteric paraaortic region from the left cornu. Conclusion Uterine cornu ICG injection using the da Vinci SP system enables successful visualization of paraaortic SLNs, supporting the feasibility of two-step SLN mapping in endometrial cancer.