Pavone Matteo, Teodorico Elena, Bizzarri Nicolò, Innocenzi Chiara, Rosati Andrea, Zorzi Michela, Cantarini Chiara, Ciancia Marianna, Moro Francesca, Gallotta Valerio, Marescaux Jacques, Lecointre Lise, Fagotti Anna, Scambia Giovanni, Fanfani Francesco, Testa Antonia, Querleu Denis
UOC Ginecologia Oncologica, Dipartimento di Scienze per la salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
ICube, Laboratory of Engineering, Computer Science and Imaging, Department of Robotics, Imaging, Teledetection and Healthcare Technologies, University of Strasbourg, CNRS, Strasbourg, France.
Ann Surg Oncol. 2025 May;32(5):3465-3466. doi: 10.1245/s10434-025-16912-x. Epub 2025 Feb 1.
Recent guidelines recommend the sentinel lymph node (SLN) technique in uterine cancers, as it is associated with lower perioperative complications. Image-guided surgery can address some limitations of SLN procedures, such as low frozen-section accuracy and risk of empty packets, by providing real-time lymph node assessment. This video describes the surgical procedure of intraoperative robotic ultrasound examination for SLN assessment.
The Arietta L43K (2-12 MHz, Hitachi, Japan) drop-in robotic ultrasound probe was used to assist with SLN dissection. The procedure was performed on the da Vinci Xi platform. The probe, introduced through an accessory trocar, was manipulated by robotic instruments, providing real-time ultrasound imaging in split-view mode on the surgeon's console. Ultrasound images, captured by the surgeon under the guidance of an experienced ultrasound examiner, were analyzed both in vivo and ex vivo. RESULTS: The procedure involves ten steps, detailed as follows. (1) The procedure begins with the cervical injection of indocyanine green. (2) The pelvic retroperitoneum is opened to allow access to anatomical landmarks. (3) Using near-infrared imaging mode, the lymphatic pathways are highlighted, allowing for the identification of the SLN. (4) Once identified, the drop-in ultrasound probe is introduced. (5) The console is switched to split-view mode, enabling the surgeon to observe ultrasound images alongside the endoscopic view. (6) In vivo imaging is conducted. (7) Both images and videos of the lymph node are captured. (8) The SLN is subsequently dissected. (9) SLN specimens are safely extracted. (10) Ex vivo ultrasound assessment is performed to further evaluate their characteristics.
Although its accuracy compared with histology as the gold standard is yet to be demonstrated, image-guided robotic lymph node ultrasound is a feasible and promising procedure for real-time SLN assessment. A prospective study is ongoing (R-LYNUS, NCT06621823) to clinically validate this technique.
近期指南推荐在子宫癌中采用前哨淋巴结（SLN）技术，因为它与较低的围手术期并发症相关。图像引导手术可以通过提供实时淋巴结评估来解决SLN手术的一些局限性，如冰冻切片准确性低和空包风险。本视频描述了用于SLN评估的术中机器人超声检查的手术过程。
使用Arietta L43K（2 - 12 MHz，日立，日本）插入式机器人超声探头辅助SLN解剖。手术在达芬奇Xi平台上进行。探头通过辅助套管针插入，由机器人器械操作，在外科医生的控制台以分屏模式提供实时超声成像。在经验丰富的超声检查人员的指导下，由外科医生采集的超声图像在体内和体外进行分析。结果：该手术包括十个步骤，详细如下。（1）手术从宫颈注射吲哚菁绿开始。（2）打开盆腔后腹膜以暴露解剖标志。（3）使用近红外成像模式突出显示淋巴路径，以便识别SLN。（4）一旦识别出SLN，插入超声探头。（5）将控制台切换到分屏模式，使外科医生能够在观察内镜视野的同时观察超声图像。（6）进行体内成像。（7）采集淋巴结的图像和视频。（8）随后解剖SLN。（9）安全提取SLN标本。（10）进行体外超声评估以进一步评估其特征。
尽管与作为金标准的组织学相比，其准确性尚未得到证实，但图像引导的机器人淋巴结超声检查是一种用于实时SLN评估的可行且有前景的手术方法。一项前瞻性研究正在进行中（R-LYNUS，NCT06621823）以临床验证该技术。
