Comparison of laparoscopic vs. robotic sentinel lymph node mapping and biopsy in  endometrial cancer

We compare the success of sentinel lymph node (SLN) biopsy between standard laparoscopy and robotic-assisted laparoscopy (RAL) in patients with endometrial cancer. Patients with uterine epithelial tumour types undergoing staging surgery were identified from January 2019 to March 2023. Included patients underwent a total hysterectomy, bilateral salpingo-oophorectomy and attempted bilateral SLN biopsy with indigocyanine green (ICG) dye, utilising either standard laparoscopy or RAL. 298 patients met the inclusion criteria. 211 (70.8%) had standard laparoscopy and 87 (29.2%) underwent RAL. The RAL cohort had significantly higher median body mass index (BMI) compared to standard laparoscopy (37 vs. 28 kg/m2, p < 0.001). The overall rate of successful bilateral SLN biopsy was 66.8% (n = 199), and at least one hemi-pelvis was successfully biopsied in 87.3% (n = 260) of patients. There was no significant difference in bilateral SLN biopsy success between RAL and standard laparoscopy (60.9% vs 69.2%, p = 0.17). RAL was not predictive of bilateral SLN biopsy success in multivariate analysis (OR 1.10, p = 0.76). There was no difference in SLN biopsy location, number of nodes identified, or empty-packet dissections between the surgical approaches. Increasing age (OR 0.96, p = 0.002) and BMI (OR 0.94, p < 0.001) were significantly associated with reduced bilateral SLN biopsy success. Between the learning and experienced periods of the study, the bilateral SLN biopsy success rate improved significantly for RAL (40.6 vs. 72.7%, p = 0.03), which was not found with standard laparoscopy. The decision to perform RAL should consider multiple factors including surgeon experience. Future research should be directed towards prospective, randomised and BMI-matched cohorts.