Huber Daniela, Hurni Yannick
Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland.
Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
Front Surg. 2022 May 9;9:907548. doi: 10.3389/fsurg.2022.907548. eCollection 2022.
The primary objective was to determine the intraoperative and postoperative surgical complications of sentinel lymph node biopsy (SLNB) by retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES). The secondary objective was to assess the feasibility of this surgical technique.
This was a descriptive study realized in a non-university hospital in Switzerland. Seven patients with endometrial cancer or endometrial complex atypical hyperplasia underwent surgical staging with SLNB by retroperitoneal vNOTES using an indocyanine green-based near-infrared fluorescence imaging technique (October 2021-February 2022).
The median operative time was 113 (81-211) minutes. The median estimated blood loss was 20 (20-400) mL. The overall bilateral detection rate was 100% (7/7). Upon histopathological examination, 5 patients presented an endometrial adenocarcinoma, and we found endometrial complex atypical hyperplasia in 2 cases. We successfully completed all procedures without significant intraoperative complications, but 1 case required conversion to conventional laparoscopy. The median postoperative stay was 2 (2-4) days, and we observed no postoperative complications during this period. We observed 1 case of postoperative deep vein thrombosis and an asymptomatic vaginal vault hematoma in the same patient.
Our preliminary study suggests that retroperitoneal vNOTES could be a feasible, safe, and valuable approach to perform SLNB in endometrial cancer. However, strong evidence of its feasibility, the effective benefits, and the long-term oncological outcomes is needed before expanding the use of vNOTES in endometrial cancer outside study settings.
主要目的是确定经腹膜后经阴道自然腔道内镜手术（vNOTES）进行前哨淋巴结活检（SLNB）的术中及术后手术并发症。次要目的是评估该手术技术的可行性。
这是一项在瑞士一家非大学医院开展的描述性研究。7例子宫内膜癌或子宫内膜复杂性非典型增生患者在2021年10月至2022年2月期间，采用基于吲哚菁绿的近红外荧光成像技术，通过腹膜后vNOTES进行SLNB手术分期。
中位手术时间为113（81 - 211）分钟。中位估计失血量为20（20 - 400）毫升。总体双侧检测率为100%（7/7）。经组织病理学检查，5例为子宫内膜腺癌，2例为子宫内膜复杂性非典型增生。我们成功完成了所有手术，术中无明显并发症，但有1例需要转为传统腹腔镜手术。中位术后住院时间为2（2 - 4）天，在此期间未观察到术后并发症。我们观察到同一患者发生1例术后深静脉血栓形成和1例无症状阴道穹窿血肿。
我们的初步研究表明，腹膜后vNOTES可能是一种可行、安全且有价值的子宫内膜癌SLNB手术方法。然而，在将vNOTES在研究环境之外广泛应用于子宫内膜癌之前，需要有其可行性、有效益处及长期肿瘤学结局的有力证据。
