Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Gynecol Oncol. 2023 Sep;34(5):e67. doi: 10.3802/jgo.2023.34.e67. Epub 2023 May 5.
Since sentinel lymph node mapping in endometrial cancer is becoming more widely used, the need of standardizing surgical technique is growing [1, 2]. The objective of this surgical video is to describe the procedure of two-step pelvic and para-aortic sentinel lymph node mapping using indocyanine green and fluorescent camera in endometrial cancer, in three versions of surgical modality of laparoscopic, robotic, and open laparotomy. The patients in the surgical video are diagnosed with biopsy-proven endometrial cancer in its early stage determined by the preoperative imaging study. After collecting washing cytology, bilateral salpinges were clamped with Endo Clip™ to minimize tumor spillage. Gauze packing in posterior cul-de-sac was done to minimize the spillage of indocyanine green dye during paraaortic sentinel lymph node mapping. Indocyanine green dye was injected in bilateral uterine fundus, to detect isolated paraaortic sentinel lymph node pathway. After bilateral paraaortic sentinel lymph node was sampled, cervical injection of Indocyanine green dye was done in 3 o'clock and 9 o'clock directions, both superficially and deeply, 2 mL in each side. After dissecting off the obliterated umbilical ligament, para-vesical and para-rectal spaces were developed. The ureter, uterine artery, and internal and external iliac vessels were identified before bilateral pelvic sentinel lymph nodes were sampled. Asan Medical Center's Institutional Review Board exempted this project. Sentinel paraaortic and pelvic lymph nodes were successfully harvested by two-step method of sentinel lymph node mapping through laparoscopic, robotic, and open laparotomy methods. This surgical video provides specific steps of pelvic and para-aortic sentinel lymph node mapping.
由于前哨淋巴结映射在子宫内膜癌中应用越来越广泛，因此对标准化手术技术的需求也在不断增加[1,2]。本手术视频的目的是描述使用吲哚菁绿和荧光摄像机在三种手术方式（腹腔镜、机器人和开腹）下对子宫内膜癌进行两步法盆腔和腹主动脉前哨淋巴结映射的过程。手术视频中的患者经术前影像学检查诊断为早期经活检证实的子宫内膜癌。在收集洗涤细胞学后，用 Endo Clip™夹住双侧输卵管以尽量减少肿瘤溢出。在后穹窿放置纱布填塞以尽量减少腹主动脉前哨淋巴结映射过程中吲哚菁绿染料的溢出。在双侧子宫底部注射吲哚菁绿染料，以检测孤立的腹主动脉前哨淋巴结途径。在对双侧腹主动脉前哨淋巴结进行取样后，在宫颈 3 点和 9 点方向分别向浅层和深层注射 2 毫升吲哚菁绿染料。在解剖闭孔脐韧带后，开发了膀胱旁和直肠旁间隙。在取样双侧盆腔前哨淋巴结之前，识别了输尿管、子宫动脉以及内、外髂血管。Asan Medical Center 的机构审查委员会豁免了该项目。通过腹腔镜、机器人和开腹手术方法，成功地通过两步法前哨淋巴结映射采集了前哨腹主动脉和盆腔淋巴结。本手术视频提供了盆腔和腹主动脉前哨淋巴结映射的具体步骤。
