180 Robotic para-aortic sentinel lymph node sampling in endometrial cancer using indocyanine green for high-risk histological subtypes and high-grade tumours

Introduction/Background Endometrial cancer represents the most common gynaecological malignancy and lymph node metastasis is the most common form of extrauterine spread of the cancer. Surgical staging of early-stage endometrial cancer, involving lymph node assessment, is of outmost importance. Sentinel lymph node (SLN) biopsy has lately been widely adopted from gynaecological oncologists worldwide as a method of lymph node assessment, as it is related to lower morbidity and less complications compared to systematic lymphadenectomy. This is a video of our technique for robotic para-aortic SLN biopsy. Methodology In our centre 1 ml of Indocyanine green (ICG) is injected in the cervix, at 3 and 9 o'clock position respectively. The steps of the procedure involve a peritoneal incision over the bifurcation of the aorta and dissection of the loose areolar tissue until the vessels are exposed. Cranial reflection of the duodenum is essential for better exposure of the para-aortic space. The ICG filter is then applied on the robotic camera in order for the SLN to be identified. The sentinel lymph node is then removed using monopolar energy. Results As shown in the video, this minimally invasive technique is associated with minimal bleeding and does not add more than 20–30 min of total surgical time. The patients are usually discharged home the following day. Conclusion Robotic para-aortic SLN biopsy for high-risk subtypes and high-grade endometrial cancers, is a procedure that allows accurate staging of the cancer and at the same time, it is associated with less risks and complications compared to full lymph-node dissection. Detection rates of the SLN are high, when a standardised technique is followed in centres with expertise in performing this procedure. Disclosures Nothing to disclose.