Transvaginal natural orifice transluminal endoscopic surgery (VNOTES) total retroperitoneal sentinel lymph node biopsy for an endometrial cancer patient with prior colon cancer surgery

Comba, Cihan; Demirayak, Gökhan; Simsek, Cigdem; Atas, Busra Seker; Özdemir, İsa Aykut

doi:10.1136/ijgc-2021-002710

Cited by 9 publications

(13 citation statements)

References 7 publications

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“…vNOTES doesn’t seem to be associated with a higher risk of DVT ( 14 ). No DVT or vaginal vault hematoma cases were reported in previous studies reporting SLNB by vNOTES ( 7 – 11 , 13 ). Although these infrequently observed intra- and postoperative complications seem not explicitly associated with our surgical technique, more extensive studies are needed to confirm its safety.…”

Section: Discussionmentioning

confidence: 74%

“…Although this technique appeared feasible without significant intraoperative complications, conversion to conventional laparoscopy was required to manage persistent pelvic bleeding in 1 case at the beginning of our series. Conversion to laparoscopy was reported only once in previous studies reporting SLNB by vNOTES ( 7 – 11 , 13 ), and it generally seems rarely required during gynecological vNOTES procedures ( 14 ). Although our case seemed associated with initial inexperience, proper hemostasis of deep vaginal vessels could be challenging with vNOTES due to the difficulty in accessing this anatomical area.…”

Section: Discussionmentioning

confidence: 99%

“…SLNB by vNOTES can be performed with a transperitoneal ( 9 ) or retroperitoneal approach ( 8 ). Although the retroperitoneal approach seems to provide better exposure of the pelvic lymph nodes, this technique has been reported only twice in the literature ( 8 , 11 ). In the present study, we report our initial experience using SLNB with a retroperitoneal vNOTES approach for the surgical staging of endometrial cancer.…”

Section: Introductionmentioning

confidence: 99%

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Sentinel Node Biopsy for Endometrial Cancer by Retroperitoneal Transvaginal Natural Orifice Transluminal Endoscopic Surgery: A Preliminary Study

Huber

Hurni

2022

Front. Surg.

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ObjectiveThe primary objective was to determine the intraoperative and postoperative surgical complications of sentinel lymph node biopsy (SLNB) by retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES). The secondary objective was to assess the feasibility of this surgical technique.MethodsThis was a descriptive study realized in a non-university hospital in Switzerland. Seven patients with endometrial cancer or endometrial complex atypical hyperplasia underwent surgical staging with SLNB by retroperitoneal vNOTES using an indocyanine green-based near-infrared fluorescence imaging technique (October 2021–February 2022).ResultsThe median operative time was 113 (81–211) minutes. The median estimated blood loss was 20 (20–400) mL. The overall bilateral detection rate was 100% (7/7). Upon histopathological examination, 5 patients presented an endometrial adenocarcinoma, and we found endometrial complex atypical hyperplasia in 2 cases. We successfully completed all procedures without significant intraoperative complications, but 1 case required conversion to conventional laparoscopy. The median postoperative stay was 2 (2–4) days, and we observed no postoperative complications during this period. We observed 1 case of postoperative deep vein thrombosis and an asymptomatic vaginal vault hematoma in the same patient.ConclusionsOur preliminary study suggests that retroperitoneal vNOTES could be a feasible, safe, and valuable approach to perform SLNB in endometrial cancer. However, strong evidence of its feasibility, the effective benefits, and the long-term oncological outcomes is needed before expanding the use of vNOTES in endometrial cancer outside study settings.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sentinel Node Biopsy for Endometrial Cancer by Retroperitoneal Transvaginal Natural Orifice Transluminal Endoscopic Surgery: A Preliminary Study

Huber

Hurni

2022

Front. Surg.

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“…Baekelandt proposed this new retroperitoneal transvaginal vNOTES approach as it enables a better exposure of retroperitoneal structures and less indocyanine leakage than transperitoneal [21]. Exposure of the major vessels and anatomic landmarks is critical to success [22].…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Sentinel Lymph Node Biopsy by Vaginally Assisted Natural Orifices Endoscopic Transluminal Endoscopic Surgery in Early Stage Endometrial Cancer: Description of Technique and Surgeon’s Perspectives after the First Experience

2022

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Endometrial cancer is the most commonly diagnosed gynecological malignancy. Feasibility and safety of laparoscopy are no longer to be demonstrated in patients with uterine-confined endometrial carcinoma. Vaginally assisted natural orifices endoscopic transluminal endoscopic surgery (vNOTES) is a new endoscopic approach over the past decade with significant evidence in benign pathology. Publications exploring VNOTES surgery in gynecological cancer were published first in 2014. We hereby report our first experience with vNOTES surgery in endometrial cancer. A 64-year-old patient presented with postmenopausal bleeding. Endometrial biopsy identified a G1 endometrioid adenocarcinoma. MRI suspected deep invasion of myometrium with no abnormal lymph node. She underwent a total hysterectomy with bilateral adnexectomy and retroperitoneal pelvic sentinel node biopsy by vNOTES. The final histopathology confirmed G1 endometrial adenocarcinoma FIGO II (proximal focal invasion of cervical stroma and superficial invasion of myometrium). The patient was discharged 2 days postoperatively with no complications. vNOTES offers a closer approach and a better view of afferent lymphatics and probably the best chances to identify the true sentinel node. This approach presents several advantages compared to abdominal laparoscopy such as faster postoperative recovery, reduced pain, decreased postoperative wound infections, and no abdominal trocar port complications. The future research should focus on oncological safety, accuracy, and reliability of this technique, and an international registry should help to gather rapidly these informations.

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“…In recent years, vNOTES has been increasingly applied to perform benign gynecologic procedures such as hysterectomy, myomectomy, several adnexal procedures, uterosacral ligament suspension, and sacrocolpopexy (14)(15)(16). To date, the role of vNOTES in gynecological oncology still requires evaluation, as only a few studies have reported on it (17)(18)(19)(20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Surgical Staging of Early-Stage Ovarian Cancers: A Report of Two Cases

2022

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Surgical staging is essential in the management of ovarian cancers. This staging has traditionally been performed by laparotomy, but minimally invasive techniques are increasingly employed. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a promising technique in the field of gynecological oncology. We report 2 cases of vNOTES surgical staging for suspicious ovarian tumors. We operated on 2 patients aged of 81 and 62 years for low-grade serous ovarian carcinoma and ovarian cystadenofibroma, respectively. We performed surgical staging with a pure vNOTES technique for the first patient and used a hybrid approach for the second. No intraoperative or postoperative complications were observed. We suggest that vNOTES is a feasible and effective approach to surgically manage early-stage ovarian cancers.

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Transvaginal natural orifice transluminal endoscopic surgery (VNOTES) total retroperitoneal sentinel lymph node biopsy for an endometrial cancer patient with prior colon cancer surgery

Cited by 9 publications

References 7 publications

Sentinel Node Biopsy for Endometrial Cancer by Retroperitoneal Transvaginal Natural Orifice Transluminal Endoscopic Surgery: A Preliminary Study

Sentinel Node Biopsy for Endometrial Cancer by Retroperitoneal Transvaginal Natural Orifice Transluminal Endoscopic Surgery: A Preliminary Study

Retroperitoneal Sentinel Lymph Node Biopsy by Vaginally Assisted Natural Orifices Endoscopic Transluminal Endoscopic Surgery in Early Stage Endometrial Cancer: Description of Technique and Surgeon’s Perspectives after the First Experience

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Surgical Staging of Early-Stage Ovarian Cancers: A Report of Two Cases

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