Toumai robotic system in uterine cancer surgery: first report of sentinel lymph node dissection in ten steps

Background: In recent years, robotic surgery has gained traction across multiple disciplines, establishing a new minimally invasive paradigm. After the Da Vinci® (Intuitive, Sunnyvale, California) patent expired, several platforms with increasingly digital interfaces entered the market. Robotic surgery may represent a bridge between laparoscopy and digital surgery through interfaces that enable integration with emerging technologies. Among platforms, the Toumai robotic system (Medbot-Microport, Shanghai, China) features a single-arm cart with four arms, a three-dimensional console, and a split-view "picture-in-picture" function enabling communication with image-guided surgical technologies. This functionality is particularly valuable for indocyanine green (ICG)-guided sentinel lymph node (SLN) mapping in gynaecologic oncology. Objectives: We present for the first time, a step-by-step video demonstration of SLN dissection for endometrial malignancies using the Toumai robotic system. Participant: A postmenopausal patient with uterine-confined endometrial carcinoma undergoing total hysterectomy, bilateral salpingo-oophorectomy, and bilateral SLN biopsy. Intervention: The technique includes: 1) ICG injection; 2) robotic trocar placement; 3) docking; 4) pelvic retroperitoneal access; 5) switch to split-view mode; 6) identification of the SLN critical view of safety by developing pararectal and paravesical spaces; 7) introduction of an ICG-capable camera through an accessory trocar; 8) activation of near-infrared visualisation after switching off the robotic light source; 9) SLN identification and dissection; 10) safe extraction. Conclusions: The digital interface of the Toumai system integrates adjunctive technologies, illustrating how next-generation robotics expand the feasibility of SLN dissection in endometrial cancers. What is New?: The Toumai platform enables SLN dissection even in the absence of an in-house integrated ICG endoscopic camera.