Robotic indocyanine green-guided sentinel lymph node mapping in early-stage cervical cancer: The fluorescent robotic indocyanine endoscopic node detection series (FRIENDS)
To describe the implementation of robotic indocyanine green (ICG)-guided sentinel lymph node (SLN) mapping for nodal staging in early-stage cervical cancer and to report mapping outcomes, anatomical distribution of SLNs, and perioperative morbidity. This single-centre cohort study included women with presumed early-stage cervical cancer who underwent robotic ICG-guided SLN mapping between 2015 and 2025. SLN mapping was performed with or without pelvic lymphadenectomy according to a side-specific algorithm. Institutional practice evolved over time from routine SLN mapping with lymphadenectomy to selective SLN-only staging. Outcomes included SLN detection rates, anatomical distribution of SLNs, nodal metastases, and postoperative morbidity. A total of 161 women underwent robotic SLN mapping. SLN detection was achieved in all patients, with bilateral mapping in 145 (90.1 %). Sixteen women (9.9 %) had nodal metastases; all metastatic disease was identified within sentinel lymph nodes. SLNs were most frequently located in the obturator and external iliac regions, with occasional upper pelvic and para-aortic drainage when lymphatic channels extended cranially. Lymphoedema occurred in 18 women (11.2 %) and was observed only in those who underwent pelvic lymphadenectomy. This study describes long-term, real-world implementation of robotic ICG-guided SLN mapping in early-stage cervical cancer. The findings demonstrate consistent SLN detection, characteristic patterns of lymphatic drainage, and a lower observed incidence of lymphoedema when lymphadenectomy is avoided, supporting the role of SLN-guided nodal staging within contemporary, algorithm-based surgical practice.