Investigator
Liverpool Hospital
Sentinel lymph node biopsy at robotic-assisted hysterectomy for atypical hyperplasia and endometrial cancer
Lymph node (LN) evaluation in endometrial cancer is controversial. Sentinel lymph node biopsy (SLNB) allows for an accurate nodal assessment while minimising the risks of a full pelvic lymph node dissection (PLND). The aims of this study are to examine the characteristics and peri-operative outcomes of women with atypical hyperplasia (AH) or endometrial cancer undergoing robotic-assisted hysterectomy (RAH) ± SLNB or PLND; to examine the utilisation, feasibility and role of SLNB and compare their peri-operative outcomes. Retrospective cohort study from December 2018 to February 2021 of women who underwent RAH ± LN assessment for endometrial cancer or AH. 115 women underwent RAH. 59% had SLNB, 29% had no LN assessment, and 12% had PLND. The final diagnosis was mostly early stage low-grade disease; Stage 1A-50%, Grade 1 endometrioid adenocarcinoma (EAC)-56%. The detection rate was 90%. There was a statistically significant trend towards performing SLNB over time (P value 0.004). There was a statistically shorter length of stay, less estimated blood loss, and shorter surgical duration in the SLNB cohort, compared to the no LN assessment cohort (P values 0.02, 0.01, and 0.03, respectively). There was statistically significant less estimated blood loss and surgical duration in the SLNB compared to the PLND cohort (P values 0.03 and 0.001, respectively). SLNB at RAH was utilised and feasible. It was safe with a low complication rate and had advantages compared to PLND cohort. SLNB should be considered in suitable selected women undergoing surgery for endometrial cancer or AH.
Robotic versus laparoscopic hysterectomy in morbidly obese women for endometrial cancer
Surgery is the mainstay treatment for endometrial cancer and complex atypical endometrial hyperplasia. These conditions are more common in the obese women and as such these patients pose additional risks and challenges to surgery. Laparoscopic hysterectomy (LH) is preferred over open surgery in obese patients as it reduces surgical morbidity. However, more recently, robotic-assisted hysterectomy (RH) has been used in morbidly obese patients to overcome the limitations of conventional laparoscopy. To compare the surgical outcomes of morbidly obese patients undergoing LH or RH for endometrial cancer or complex atypical hyperplasia. A retrospective analysis of morbidly obese patients (BMI > 40 kg/m
