Sentinel Node Biopsy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery in a Patient with Early-Stage Cervical Cancer: A Case Report

Abstract

Sentinel lymph node biopsy (SLNB) has emerged as an accurate tool to identify lymph node metastases in patients with cervical cancers. This procedure is generally performed by conventional or robotic-assisted laparoscopy, but SLNB by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been described for the surgical staging of endometrial cancer. This transvaginal approach seems to be associated with reduced surgical morbidities and could be of particular interest in managing cancer patients. In this article, we report the use of a retroperitoneal vNOTES approach to perform SLNB in a patient with cervical cancer, and we provide a step-by-step description of the surgical technique. This surgical approach seems to be the least invasive way to perform pelvic SLNB and could represent a valuable approach to properly managing patients with early-stage cervical cancers after a free-margin conization. However, more studies are needed before expanding the use of this surgical approach outside study settings.

Sentinel Lymph Node Mapping by Retroperitoneal vNOTES for Uterus-Confined Malignancies: A Standardized 10-Step Approach

“…We proposed a standardized 10-step approach for SLN mapping by retroperitoneal vNOTES for patients with early-stage endometrial and cervical cancer. Since Baekelandt first described this technique in 2019 [ 12 ], only a few articles have been published on this topic, including case reports, small single-center case series, and proposals for technique modifications [ 14 , 15 , 16 , 17 , 18 , 19 , 22 ]. Following the IDEAL (Idea Development Exploration Assessment Long-term follow-up) framework, we can consider that research regarding this technique is in Stage 2a (Development), and its standardized description appeared necessary before moving to Stage 2b (Exploration), allowing for a greater surgical homogeneity required to conduct larger multi-center studies.…”

“…The retroperitoneal vNOTES approach appears to be the most promising, providing easy visualization of lymphatic afferent vessels and pelvic lymph nodes (LNs), early LN assessment, and a coherent mapping methodology following the lymphatic flow from caudal to cranial [ 14 ]. Although this technique appears to be a possible revolutionary tool to stage endometrial and cervical cancer, only a few publications have reported it [ 12 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

Clinical relevance of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecology

“…Regarding other gynecological malignancies, only one case report has been published regarding vNOTES SLN biopsy in early-stage cervical cancer [ 35 ]. Similar benefits have been observed in sentinel node biopsies for endometrial cancer staging.…”

Analysis and suggestions on the complications in 2000 cases of transvaginal natural orifice transluminal endoscopic surgery: Can it be a conventional surgery?

“…Since the first vNOTES of the adnexa was reported in 2012, [1][2][3] this approach has been widely used in various gynecologic procedures, such as salpingectomy, ovarian cyst removal, adnexectomy, hysterectomy, lymphadenectomy (sentinel, dissection), and pelvic floor repair. [3][4][5][6][7][8] Compared with laparoendoscopic single-site surgery (LESS), vNOTES has the advantages of mild postoperative pain, earlier anal exhaust time, and the absence of superficial scarring. [9][10][11][12][13] However, as a new surgical approach, perioperative complications are crucial assessment indicators in addition to confirming the feasibility and advantages of vNOTES.…”

“…The gynecologic surgical approach has advanced from open surgery to laparoscopy, natural orifice transluminal endoscopic surgery (NOTES), and transvaginal NOTES (vNOTES). Since the first vNOTES of the adnexa was reported in 2012, 1–3 this approach has been widely used in various gynecologic procedures, such as salpingectomy, ovarian cyst removal, adnexectomy, hysterectomy, lymphadenectomy (sentinel, dissection), and pelvic floor repair 3–8 . Compared with laparoendoscopic single‐site surgery (LESS), vNOTES has the advantages of mild postoperative pain, earlier anal exhaust time, and the absence of superficial scarring 9–13 …”