Intraoperative near infrared fluorescence for detecting sentinel lymph nodes in the robotic surgical approach of endometrial cancer

Fabio Barra, Franco Alessandri, Giulio Evangelisti, Claudio Gustavino, Simone Ferrero, Maria Grazia Centurioni

Abstract

In recent years sentinel lymph node (SLN) mapping has emerged as an attractive investigational approach for the treatment of gynecological cancers, and in particular, endometrial cancer (EC). In fact, radical lymphadenectomy may have no therapeutic benefit in patients with early-stage EC who have low probability of lymph nodes involvement; subsequently, SLN mapping may decrease unnecessary lymph node dissections. In recent years, the number of minimally invasive procedures for gynecologic oncology has increased, with robotic procedures rising remarkably. Robotic SLN evaluation by intraoperative near infrared fluorescence (INIF) imaging system (Firefly™, Intuitive Surgical Inc., Sunnyvale, CA, USA) is an innovative surgical tool, which allows for a rapid conversion from the normal robotic view to that for detecting fluorescent indocyanine green (ICG). The aim of this video is to describe the use of this tool and technical outcomes of SLN dissection during our single-center experience in the robotic surgical approach of patients with early endometrial cancer.