Sentinel-lymph-node mapping with indocyanine green in robotic-assisted laparoscopic surgery for early endometrial cancer: a retrospective analysis

Background: The therapeutic value of lymphadenectomy in early stage endometrial cancer (EC) is still debated. Sentinel-h mph-node identified with indocyanine green (ICG) can replace lymphadenectomy in the staging of endometrial cancer minimizing the potential morbidity of a complete lymphadenectomy. The aim of this study was to analyze our initial experience using indocyanine green for sentinel-lymph-node mapping in a minimally robotic-assisted laparoscopic approach with Da Vinci XI near-infrared (MR) fluorescence imaging system. Methods: A total of 23 patients who underwent robot-assisted laparoscopic surgery with the Da Vinci Xi Surgical System (Intuitive Surgical, Sunny ale, CA, USA) with NM imaging and ICG fluorescence detection for early stage EC were retrospectively analyzed. Results: Sentinel-lymph-node mapping was achieved in 18 patients for a detection rate of 78.26%, bilateral pelvic detection was possible in 14 patients (60.9%) and no sentinel-lymph-node mapping was noted in 4 patients (17.4%). We compared 11 patients (Group 1) at intermediate and high- risk of recurrence who underwent sentinel-lymphnode mapping and pelvic lymphadenectomy and 12 patients (Group 2) at low risk of recurrence who underwent only sentinel-lymph-node mapping. A statistically significant difference was found for the average operation time and for the hospital stays. Conclusion: The high detection rate, absence of intraoperative or postoperative complications, the short time required for mapping and removal of the sentinel-lymph-nodes and the short duration of the hospital stay, support performing sentinel-lymph-node in all women with early endometrial cancer.