Endoscopic sentinel lymph node identification with laparoscopically-assisted surgical staging of endometrial carcinoma: A case report

Objective: The majority of patients undergoing lymphadenectomy for endometr ial cancer do not have node involvement. We describe an endoscopic surgical approach to endometrial cancer consisting of an endoscopic sentinel lymph node procedure followed by laparoscopically-assisted surgical staging and l aparoscopically-assisted vaginal hysterectomy. Case Report: A 64-year old patient was referred for treatment of early endo metrial cancer. 24 hours before surgery 1ml Tc-99m-labeled nanocolloid was injected into the endometrium and myometrium around the tumor with a 6-mm h ysteroscope. Lymphoscintigraphy at 6 hours showed tracer accumulation in th e regional lymph nodes. At laparoscopy a gamma probe was used endoscopicall y to identify and remove the nodes in the sentinel region. Endoscopic stagi ng lymphadenectomy and laparoscopically-assisted vaginal hysterectomy were performed. Conclusion: This procedure appears feasable to identify sentinel lymph node s in patients with endometrial cancer. It should decrease surgical morbidit y and yield sufficient pathologic information. We are planning a prospectiv e trial in patients with early endometrial cancer.