Surgical staging for apparent early stage ovarian cancer includes systematic pelvic and paraaortic lymph node evaluation to detect occult stage III disease. Though lymphadenectomy procedure is associated with increased duration of surgery and a 13 percent risk of lymphocyst formation. Sentinel lymph node (SLN) biopsy is still investigational, and no standardized approach has been studied. Recent mounting evidence has approved the applicability of SLN technique in early stage ovarian cancer. The objective of this video is to demonstrate a surgical technique for robotic performance of SLN biopsy in presumed early-stage ovarian cancer.
Stepwise demonstration of the robotic technique for SLN sampling in presumed early stage ovarian cancer. This video report is part of an institutional, Investigational Review Board-approved study.
An academic tertiary referral center.
This video presents our team’s robotic technique for SLN sampling in a 37-year-old woman who presented to our center with 10 cm right complex adnexal mass, suspicious for malignancy. A 27-gauge spinal needle was inserted through the abdominal wall under direct visualization. We injected 0.5 mL of dilute indocyanine green (ICG) solution (Novadaq Technologies, Mississauga, ON, Canada) (1.25 mg/mL) subperitoneally into the utero-ovarian ligament. The SLN was checked with the fluorescence-guided camera of the Xi DaVinci robotic system (Sunnyvale, California). 8-10 minutes after the injection, a right para-aortic SLN was identified and dissection was performed. After dissection, the node was extracted and sent to pathologic evaluation by ultra-staging. Final pathology revealed a stage IA low grade serous ovarian cancer.
SLN sampling appears to be feasible in presumed early-stage ovarian cancer and may allow the avoidance of systematic lymph node dissection in this set of patients.
Copyright © 2020. Published by Elsevier Inc.