Comparison of Different Near-Infrared Technologies to Detect Sentinel Lymph Node in Uterine Cancer: A Prospective Comparative Cohort Study

Abstract

Objectives: Sentinel lymph node biopsy is considered a crucial step in endometrial cancer staging. Cervical injection has become the most favored technique and indocyanine green has been demonstrated to be more accurate than other tracers. Different near-infrared camera systems are currently being used to detect indocyanine green in sentinel lymph nodes and have been compared in different patients. The present study aimed to determine the number and site of sentinel lymph nodes detected in the same patients with two different near-infrared technologies. Methods: This is a prospective, single-center, observational, non-sponsored study. Patients with presumed uterine-confined endometrial cancer were prospectively enrolled. After cervical injection, two different near-infrared cameras were used to detect sentinel lymph nodes at the same time: Olympus, Tokyo, Japan—considered the standard (SNIR); and Medtronic, Minneapolis, MN, USA with VISION SENSE® which is a new laser near-infrared (LNIR) fluorescence laparoscope. The two cameras were alternatively switched on to detect sentinel lymph nodes in the same patients. Results: Seventy-four consecutive patients were included in the study. Most of the patients were diagnosed with endometrioid histology (62, 83.8%), FIGO stage IA (48, 64.9%), grade 2 (43, 58.1%), and underwent surgery with laparoscopic approach (70, 94.0%). The bilateral detection rate was 56/74 (75.7%) with SNIR and 63/74 (85.1%) with LNIR (p = 0.214). The total number of sentinel lymph nodes identified in the left hemipelvis was 65 and 70 with SNIR and LNIR, respectively; while in the right hemipelvis, there were 74 and 76, respectively. The median number of sentinel lymph nodes identified with SNIR and LNIR was 2 (range, 0–4) and 2 (range, 0–4), respectively (p = 0.370). No difference in site of sentinel lymph node detection was evident between the two technologies (p = 0.994). Twelve patients (16.2%) had sentinel lymph node metastasis: in all cases metastatic sentinel lymph nodes were detected both with Olympus and LNIR. Conclusions: No difference in bilateral detection rate and number or site of sentinel lymph node detection was evident comparing two different technologies of near-infrared camera for ICG detection in endometrial cancer patients. No difference in sentinel lymph node metastases identification was detected between the two technologies.

Robotic surgery for deep-infiltrating endometriosis: is it time to take a step forward?

“…In a recent meta-analysis by Restaino et al (35), the safety of robotic-assisted surgery was confirmed with a comparable rate of intra-and post-operative complications. In addition, the authors reported similar estimated blood loss quantities between the two groups.…”

“…Nonetheless, very few studies that compared the two minimally invasive approaches in patients with r-ASRM stage III/IV endometriosis are available. To the best of our knowledge, there are only one randomized-controlled trial (RCT) ( 33 ) and two meta-analyses ( 34 , 35 ) in that regard.…”

“…In addition, the authors reported similar estimated blood loss quantities between the two groups. Moreover, robotic-assisted surgery was associated with longer operative time compared to laparoscopic surgery, even when excluding the docking time ( 35 ). Nonetheless, the authors concluded that the heterogeneity in outcomes of the included studies and the focus on the peri-operative window did not allow any conclusions on long-term pain relief, quality of life and fertility results ( 34 , 35 ).…”

“…Moreover, robotic-assisted surgery was associated with longer operative time compared to laparoscopic surgery, even when excluding the docking time ( 35 ). Nonetheless, the authors concluded that the heterogeneity in outcomes of the included studies and the focus on the peri-operative window did not allow any conclusions on long-term pain relief, quality of life and fertility results ( 34 , 35 ). Moreover, some of the considered studies enrolled both mild and severe endometriosis ( 33 , 41 ) while other authors failed to report the stage of the disease, which contributed to the wide heterogeneity in the included population.…”