Huber Daniela, Hurni Yannick
Department of Gynecology and Obstetrics, Valais Hospital, Av. Du Grand-Champsec 80, 1951 Sion, Switzerland.
Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Bd. de la Cluse 30, 1205 Geneva, Switzerland.
Cancers (Basel). 2024 Jun 5;16(11):2142. doi: 10.3390/cancers16112142.
(1) Background: Sentinel lymph node (SLN) mapping represents an accurate and feasible technique for the surgical staging of endometrial and cervical cancer. This is commonly performed by conventional laparoscopy or robotic-assisted laparoscopy, but in recent years, a new retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach has been described and developed by Jan Baekelandt. This technique provides easy visualization of lymphatic afferent vessels and pelvic lymph nodes, early SLN assessment, and a coherent mapping methodology following the lymphatic flow from caudal to cranial. However, only a few publications have reported it. Following the IDEAL (Idea Development Exploration Assessment Long-term follow-up) framework, research concerning this technique is in Stage 2a, with only small case series as evidence of its feasibility. Its standardized description appears necessary to provide the surgical homogeneity required to move further. (2) Methods: Description of a standardized approach for retroperitoneal pelvic SLN mapping by vNOTES. (3) Results: We describe a 10-step approach to successfully perform retroperitoneal vNOTES SLN mapping, including pre-, intra-, and postoperative management. (4) Conclusions: This IDEAL Stage 2a study could help other surgeons approach this new technique, and it proposes a common methodology necessary for evolving through future IDEAL Stage 2b (multi-center studies) and Stage 3 (randomized controlled trials) studies.
(1) 背景：前哨淋巴结（SLN）定位是子宫内膜癌和宫颈癌手术分期的一种准确且可行的技术。这通常通过传统腹腔镜或机器人辅助腹腔镜来进行，但近年来，扬·贝克兰特描述并开发了一种新的经阴道后腹膜自然腔道内镜手术（vNOTES）方法。该技术能轻松观察淋巴输入血管和盆腔淋巴结，实现早期SLN评估，并提供一种从尾端到颅端遵循淋巴引流的连贯定位方法。然而，仅有少数出版物报道过它。按照IDEAL（构思、开发、探索、评估、长期随访）框架，关于该技术的研究处于2a阶段，仅有小病例系列作为其可行性的证据。似乎有必要对其进行标准化描述，以提供进一步发展所需的手术同质性。(2) 方法：描述一种通过vNOTES进行腹膜后盆腔SLN定位的标准化方法。(3) 结果：我们描述了一种成功进行腹膜后vNOTES SLN定位的10步方法，包括术前、术中和术后管理。(4) 结论：这项IDEAL 2a阶段研究可帮助其他外科医生采用这种新技术，并且它提出了在未来IDEAL 2b阶段（多中心研究）和3阶段（随机对照试验）研究中进一步发展所必需的通用方法。
