Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
Gynecologic Oncology Unit, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
J Minim Invasive Gynecol. 2018 Mar-Apr;25(3):461-466.e1. doi: 10.1016/j.jmig.2017.10.003. Epub 2017 Oct 13.
To compare 3-mm minilaparoscopy and standard 5-mm laparoscopy for sentinel lymph node (SLN) detection in apparent early-stage endometrial cancer (EC).
Retrospective study (Canadian Task Force classification II-2).
Two academic research centers.
Consecutive women with apparent early-stage EC who underwent surgical staging with SLN detection between November 2015 and April 2016.
The surgical approach was a total laparoscopic extrafascial hysterectomy plus bilateral salpingo-oophorectomy and SLN detection. Systematic lymphadenectomy was performed in selected cases. In all patients, SLN detection was performed with cervical injection of indocyanine green and the use of an optical camera with a near-infrared high-intensity light source for detection of fluorescence imaging. All patients who underwent a minilaparoscopic approach (using one 5-mm scope and three 3-mm ancillary trocars) have been enrolled at the University of Insubria, whereas at the San Gerardo Hospital, standard laparoscopy was performed with one 10-mm scope and three 5-mm ancillary trocars.
A total of 38 patients were enrolled, including 15 (39.5%) in the 3-mm group and 23 (60.5%) in the 5-mm group. No between-group differences were found in terms of demographic and tumor characteristics. Bilateral SLNs were detected in 73.3% of the patients in the 3-mm group and in 73.9% in the 5-mm group. Operative time, blood loss, hemoglobin drop, hospital stay, and the incidence and severity of complications were similar in the 2 groups. One patient (4.3%) in the standard 5-mm group had a positive SLN result (a micrometastasis in the left external iliac SLN). No positive SLNs were detected in the 3-mm group.
Minilaparoscopic SLN biopsy appears to be a promising and feasible technique for EC staging. Further research is warranted to investigate the possible benefits of 3-mm instruments in this specific setting.
比较 3mm 微创腹腔镜与标准 5mm 腹腔镜在明显早期子宫内膜癌（EC）前哨淋巴结（SLN）检测中的应用。
回顾性研究（加拿大任务组分类 II-2）。
两个学术研究中心。
2015 年 11 月至 2016 年 4 月期间接受手术分期和 SLN 检测的连续明显早期 EC 女性患者。
手术方法为全腹腔镜筋膜外子宫切除术加双侧输卵管卵巢切除术和 SLN 检测。在选定病例中进行系统淋巴结切除术。在所有患者中，通过宫颈注射吲哚菁绿和使用带有近红外高强度光源的光学摄像机进行 SLN 检测，以检测荧光成像。所有接受微创腹腔镜方法（使用一个 5mm 腹腔镜和三个 3mm 辅助套管）的患者均在因斯布鲁克大学登记，而在圣杰尔达医院，标准腹腔镜使用一个 10mm 腹腔镜和三个 5mm 辅助套管进行。
共纳入 38 例患者，其中 3mm 组 15 例（39.5%），5mm 组 23 例（60.5%）。两组患者的人口统计学和肿瘤特征无差异。3mm 组中 73.3%的患者双侧 SLN 被检出，5mm 组中 73.9%的患者双侧 SLN 被检出。两组的手术时间、出血量、血红蛋白下降量、住院时间以及并发症的发生率和严重程度相似。标准 5mm 组中有 1 例（4.3%）患者 SLN 阳性（左侧髂外 SLN 微转移）。3mm 组未检测到阳性 SLN。
微创腹腔镜 SLN 活检似乎是一种有前途且可行的 EC 分期技术。需要进一步研究来探讨 3mm 器械在这种特定情况下的可能益处。
