Minilaparoscopy vs. Standard Laparoscopy for Sentinel Node Dissection: a Pilot Study (jmig.org)
Abstract
Objective
To compare 3-mm minilaparoscopy and standard 5-mm laparoscopy for sentinel node (SLN) detection in apparent early stage endometrial cancer (EC).

Design
Retrospective study (Canadian Task Force II-2).

Setting
Two academic research centers.

Patients
Consecutive women with apparent early stage EC, who underwent surgical staging with SLN between November 2015 and April 2016.

Interventions
Total laparoscopic extrafascial hysterectomy + bilateral salpingo-oophorectomy and SLN attempt. Systematic lymphadenectomy was performed in selected cases. In all patients, SLN detection was performed with cervical injection of indocyanine green and the use of an optical camera with a near-infrared high intensity light source for detection of fluorescence imaging. All patients who underwent minilaparoscopic approach (using a 5-mm scope and three 3-mm ancillary trocars) have been enrolled at the University of Insubria – Varese, whereas at the San Gerardo Hospital – Monza, standard laparoscopy was performed with a 10-mm scope and three 5-mm ancillary trocars.

Main Outcome Measures
Peri-operative surgical outcomes.

Result(s)
A total of 38 patients were included: 15 (39.5%) in the 3-mm and 23 (60.5%) in the 5-mm group.

No differences were found between groups in terms of demographic and tumor characteristics.

Bilateral SLN detection was obtained in 73.3% and 73.9% in the 3-mm and 5-mm groups, respectively. Operative time, blood loss, hemoglobin drop, hospital stay, incidence and severity of complications were similar between groups. One patient (1/23, 4.3%) in the standard 5-mm group had positive SLN (a micrometastasis in the left external iliac SLN). No potitive SLNs were revealed in the 3-mm group.

Conclusions
Minilaparoscopic SLN biopsy appears as a feasible and promising technique in EC staging. Further research is warranted, in order to investigate the possible benefits of 3-mm instruments in this specific setting.