Retroperitoneal sentinel lymph node biopsy using vNOTES in endometrial cancer patients with a BMI ≥ 30 kg/m2: a pilot multicenter case series by the Turkish gynecologic oncology group (TRSGO-SLN12)

Abstract

AimThis study evaluated the feasibility and surgical outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for retroperitoneal sentinel lymph node biopsy (SLNB), specifically targeting obese and morbidly obese patients diagnosed with endometrial cancer (EC).MethodsPathohistological evaluation confirmed the diagnosis of either Grade I or II endometrioid EC in all participants.ResultsIn total, 31 patients participated in this study. The median age was 56 [43-75] years and the median BMI was 34 [30-54] kg/m2. Near-infrared fluorescence imaging utilizing ICG was implemented in 17 cases (54.8%), while methylene blue dye was used in 14 cases (45.2%). A median, 4 sentinel lymph nodes (SLNs) were excised per patient, with numbers ranging from 1 to 7. The overall SLN detection rate was 90.3%, with unilateral detection in 9.7% of patients and bilateral detection in 80.6%. During the surgery, two complications occurred, and an additional two developed afterward. In 3.2% of cases, it was required to switch to a conventional laparoscopic procedure. Lymphatic metastases were identified in 3 patients (9.7%). The median hospital stay was 2 days.ConclusionvNOTES can be a viable alternative to retroperitoneal SLNB, providing distinct benefits, especially for obese and morbidly obese patients with EC.