Erkan Şimşek

Comparison of robotic and natural orifice transluminal endoscopic surgical technique procedures in patients undergoing sentinel lymph node biopsy during endometrial cancer surgery

The role of sentinel lymph node dissection in the surgical management of endometrial cancer limited to the uterus is gaining recognition. The safety and applicability of two methods were assessed by examining the results of our patients in the identification of the sentinel lymph node during endometrial cancer surgery. The methods were robotic surgery, a critical component of minimally invasive surgery, and the vNOTES (Natural Orifice Transluminal Endoscopic Surgery Technique), which has recently been introduced for malignant indications. Patients who had endometrial cancer surgery at our center employing robotic and vNOTES technologies between January 2023 and June 2024 were included in this retrospective study. We conducted the dissection of sentinel lymph nodes utilizing a near-infrared technology camera method with indocyanine green (ICG) in both robotic and vNOTES techniques. The patients' records were retrospectively obtained from patient files and hospital records. Among the 76 patients who underwent surgery for endometrial cancer, 24 were treated with vNOTES surgery, whereas 52 received robotic surgery. No statistically significant differences were seen between the two groups for age (p = 0.447), body mass index (p = 0.506), prior abdominal operations (p = 0.209), predicted blood loss (p = 0.155), and surgical duration (p = 0.298). The detection rates of sentinel lymph nodes (SLN) were similar across the groups: 97 % (n = 50) in the robotic group and 96 % (n = 23) in the vNOTES group (p = 0.493). The only statistically significant difference was observed in postoperative pain scores at the 12th hour, which were lower in the vNOTES group (p = 0.023). The vNOTES technique demonstrates comparable sentinel lymph node detection rates to robotic surgery in the management of uterine endometrial cancer. Moreover, it has the advantage of markedly less postoperative discomfort. vNOTES is a secure and efficacious minimally invasive option, especially for patients with comorbidities or those deemed unsuitable for robotic surgery.

vNOTES scarless and painless endometrial cancer staging surgery

AbstractAimsSentinel lymph node dissection is performed in endometrial cancer surgery instead of staging surgery, particularly when the disease is advanced and confined to the uterus. The aim of this study is to share our sentinel lymph node detection rates via the vaginal natural orifice transluminal endoscopic surgery method with the literature and to demonstrate a safer and more comfortable surgical treatment process.MethodsThe analysis includes the patients who underwent surgery sentinel lymph node dissection for endometrial cancer utilizing indociyanin green in our center between January 2022 and June 2024.ResultsIn all, of 24 endometrial cancer patients underwent surgery sentinel lymph node dissection, nonendometrioid (serous) pathology was observed in only 1 (4%) patient, our other patients (96%) had endometrioid adenocarcinoma pathology. The rates of our sentinel lymph node dissection bilateral and symmetric are 96% (23/24), 94% (22/24), and 79% (19/24), respectively. We would like to emphasize that we successfully used vaginal natural orifice transluminal endoscopic surgery approach on four of our patients who were unsuitable for laparoscopic and robotic surgery due to pain scores of 2 at the 12th hour after surgery and low lung capacity.ConclusionsVaginal natural orifice transluminal endoscopic surgery and sentinel lymph node dissection will be considered as surgical options in other gynecological cancers due to the comfort it brings to the patient in endometrial cancer.

Robotic sentinel lymph node dissection experiences in endometrial cancer at our tertiary cancer treatment institution

In endometrial cancer surgery, sentinel lymph node dissection is used instead of staging surgery, particularly in advanced disease that is limited to the uterus. The aim of this study is to evaluate our practice of robotic sentinel lymph node dissection, which is applied to endometrial cancer patients in our tertiary cancer treatment center, according to the current literature, and to share our own data. Included in our analysis are patients who underwent robotic sentinel lymph node dissection for endometrial cancer utilizing indocyanine green in our center between January 2018 and January 2024. In all, of the 93 endometrial carcinoma patients who underwent sentinel lymph node biopsy, 63 were classified as low-risk, while 30 were high-risk according to the European Society of Gynaecological Oncology and National Comprehensive Cancer Network guidelines. We found sentinel lymph nodes in both low-risk and high-risk patients, with an overall sensitivity of 96.32% (95% confidence interval [CI], 85.12-99.71), specificity of 100% (95%CI, 92.20-99.8), negative predictive value of 96.72% (95%CI, 87.03-99.89), and negative likelihood ratio of 0.06 (95%CI, 0.01-0.36). After evaluating our data retrospectively, we determined that we were compatible with the current literature.