title: Fluorescence-assisted sentinel (SND) and pelvic node dissections by single-port transvaginal laparoscopic surgery, for the management of an endometrial carcinoma (EC) in an elderly obese patient.
abstract: OBJECTIVE
  To explore the feasibility of an oncologically acceptable management for an intermediate-risk endometrial cancer (EC) in an elderly, using the combination of transvaginal single-port laparoscopy and sentinel node policy.
  
  
  METHODS
  For this 85-years old patient, BMI 32kg/m2, with IB grade 2 endometrioid EC, a single vaginal approach was attempted [1] to perform a total hysterectomy, bilateral salpinago-oophorectomy and pelvic node assessment guided by SND [2]. Injections of indocyanine green (ICG) were performed at 3 and 9 o'clock and 2 depths [3] into the uterine cervix A simple vaginal hysterectomy was first performed using a 5mm vessel sealer (LigaSure®-Medtronics) to limit ICG leakage. As poorly accessible, adnexas were divided close to cornuas; uterine corpus was delivered vaginally. Then, a single port device (Gelpoint®-Applied), equipped with 3 trocars for optique and instruments, was installed through vagina. After transvaginal pneumoperitoneum insufflation, bowel loops were cleared from the pelvis. Latero-pelvic peritoneum was incised between external iliac pedicles and ureters. Following the algorithm, node dissection was limited to sentinel node clearly identified on the right side under color-segmented fluorescence (Pinpoint®-Novadaq), but a full pelvic dissection completed an unsatisfactory SND on the left side. Procedure was terminated with salpingo-oophorectomies. After protected vaginal specimen delivery, the single-port device was removed and vagina was closed as usual.
  
  
  RESULTS
  Patient was discharged on the 1st post-operative day. Final pathology confirmed the FIGO stageIB grade2 EC.
  
  
  CONCLUSIONS
  A transvaginal laparoscopic pelvic SND after vaginal hysterectomy is feasible. This single-port "NOTES" strategy bridges the previous gaps of a pure vaginal approach and seems interesting in fragile EC patients.
authors.affiliation: Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France. Electronic address: e-leblanc@o-lambret.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Leblanc
authors.affiliation: Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Narducci
authors.affiliation: Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Bresson
authors.affiliation: Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Hudry
mesh_terms: D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D007208:Indocyanine Green; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D009765:Obesity / Q000150:complications; D061848:Optical Imaging; D010052:Ovariectomy / Q000379:methods*; D010388:Pelvis; D058994:Salpingectomy / Q000379:methods*; D000071036:Sentinel Lymph Node / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D014621:Vagina
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Endometrial cancer; Laparoscopy; NOTES; Sentinel node; Single-port; Vaginal surgery