Assessment of sentinel nodes for gynecologic malignancies by natural orifices transluminal endoscopic surgery (NOTES): Preliminary report

ObjectiveTo assess the feasibility of sentinel lymph node (SLN) biopsy in gynecologic malignancies using natural orifices transluminal endoscopic surgery (NOTES) in an animal model.MethodsTen female pigs were operated. Patent blue dye was injected in the paracervical region. The endoscope was introduced through a right lateral colpotomy. Internal iliac vessels were visualized followed by the identification of external iliac vessels. Bilateral dissection was performed to achieve visualization of the aorta and the vena cava. SLN colored in blue were bluntly dissected and then excised.ResultsMean operative time was 56 ± 16 minutes. The mean number of SLN retrieved was 1.75 ± 1.28. All but one SLN were identified by NOTES procedure. No major complication was observed in this series. A total of 19 SLN were harvested, of which 11 from the left side and 8 from the right side. Fifteen lymph nodes were obtained from the iliac vessels or the promontory and 4 from the lateral aortic or preaortic region.ConclusionsIn this study, we confirmed the feasibility of the SLN technique by NOTES. It can be considered as a potential alternative to reduce morbidity during staging procedures for gynecologic malignancies. Prospective randomized series are necessary to establish the safety and the real benefits of this new technique.