Gynaecologic Oncology Unit, Mater Hospital, Brisbane, Australia.
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
J Obstet Gynaecol. 2021 May;41(4):642-646. doi: 10.1080/01443615.2020.1789953. Epub 2020 Aug 19.
Indocyanine green (ICG) and near infra-red fluorescence imaging in minimally invasive surgery is an option to map sentinel lymph nodes (SLN). The aim of this study was to compare the outcomes of SLN mapping between laparoscopic and robotic surgery. One-hundred-and-forty women with histologically confirmed endometrial cancer, were treated with a minimally invasive hysterectomy, bilateral salpingo-oophorectomy and SLN mapping. After anaesthetic induction, ICG was superficially injected into cervical submucosa and deeply injected into the cervical stroma at the 3 and 9 o'clock positions (1.25 mg/site). Eleven cases were abandoned after ICG injection (laparoscopic surgery seven cases and robotic surgery four cases) because of obesity, technical difficulty and peritoneal disease. One-hundred-and-eleven patients were analysed. Seventy-six patients had a laparoscopic procedure and 33 patients had robotic surgery. The overall and bilateral detection rates were 97% and 83% for laparoscopic surgery and 88% and 73% for robotic surgery. Laparoscopic surgery was superior to robotic surgery in terms of overall detection (-value .046). There was no significant difference in the intra-operative SLN identification time or SLN dissection time between laparoscopy and robotic surgery (-value .247 and .145, respectively). Further research is required to compare laparoscopy and robotic surgery in terms of SLN detection.Impact Statement Sentinel lymph node (SLN) mapping aims to avoid complications and provide useful staging information for endometrial cancer. ICG has been shown to improve the detection rate and NPV compared with other tracers (blue dye and technetium 99). No data exists comparing SLN mapping rates using ICG in laparoscopy and robotic surgery. The overall and bilateral detection rates were 97% and 83% for laparoscopic surgery and 88% and 73% for robotic surgery. Laparoscopic surgery was superior to robotic surgery in terms of overall detection. There was no significant difference in the intra-operative SLN identification time or SLN dissection time between laparoscopy and robotic surgery.: This study confirms that laparoscopy and robotic surgery are not different in terms of bilateral detection rate and SLN operating time; the study population is small.
吲哚菁绿（ICG）和近红外荧光成像在微创手术中是一种用于定位前哨淋巴结（SLN）的方法。本研究旨在比较腹腔镜和机器人手术中 SLN 定位的结果。140 名组织学证实为子宫内膜癌的女性接受了微创子宫切除术、双侧输卵管卵巢切除术和 SLN 定位。麻醉诱导后，将 ICG 浅层注射到宫颈黏膜下，深层注射到宫颈基质的 3 点和 9 点位置（每个位置 1.25mg）。在 ICG 注射后，由于肥胖、技术难度和腹膜疾病，11 例（腹腔镜手术 7 例，机器人手术 4 例）被放弃。111 例患者进行了分析。76 例患者行腹腔镜手术，33 例患者行机器人手术。腹腔镜手术的整体和双侧检测率分别为 97%和 83%，机器人手术分别为 88%和 73%。腹腔镜手术在整体检测方面优于机器人手术（-值.046）。腹腔镜和机器人手术在 SLN 术中识别时间或 SLN 解剖时间方面无显著差异（-值.247 和.145）。需要进一步研究比较腹腔镜和机器人手术在 SLN 检测方面的差异。
前哨淋巴结（SLN）定位旨在避免并发症，并为子宫内膜癌提供有用的分期信息。ICG 已被证明与其他示踪剂（蓝色染料和锝 99）相比，可提高检测率和阴性预测值。目前尚无比较腹腔镜和机器人手术中使用 ICG 进行 SLN 定位的研究。腹腔镜手术的整体和双侧检测率分别为 97%和 83%，机器人手术分别为 88%和 73%。腹腔镜手术在整体检测方面优于机器人手术。腹腔镜和机器人手术在 SLN 术中识别时间或 SLN 解剖时间方面无显著差异。本研究证实，腹腔镜和机器人手术在双侧检测率和 SLN 手术时间方面无差异；研究人群较小。
