vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging - First multicenter, prospective case series

Sep 21, 2026

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Prospective multicenter evaluation of retroperitoneal vNOTES sentinel lymph node dissection for endometrial cancer staging. Sixty-four women with early-stage endometrial carcinoma underwent transvaginal retroperitoneal vNOTES, entering the paravesical space after cervix injection with indocyanine green, then identifying sentinel nodes with near-infrared light and endoscopic removal. Bilateral sentinel nodes were identified in 97% of cases; 60 had negative nodes, 3 showed isolated tumor cells, and 1 had macroscopically positive nodes, with no reported sequelae complications. All patients subsequently received vNOTES hysterectomy and bilateral salpingo-oophorectomy.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Material and methods

Results

Conclusions

DOI: 10. 1111/aogs.14843 OR I G I NAL R E S E AR C H ART I C L E vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series Jan Baekelandt1,2 | Astrid Jespers1 | Daniela Huber3,4 | Levon Badiglian-Filho5 | Andrea Stuart6 | Linus Chuang7 | Oudai Ali8 | Alexander Burnett9,10 1Department of Gynecology, Imelda Hospital, Bonheiden, Belgium 2Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Leuven, Belgium 3 Department of Obstetrics and Gynecology, Sion Hospital, Sion, Switzerland 4Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland 5Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil 6Department of Obstetrics and Gynecology, Institute for Clinical Sciences, Lund University, Lund, Sweden 7Department of Gynecologic Oncology, Nuvance Health, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA 8 Department of Gynecology, Epsom and St Helier University, London, UK 9Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA 10The Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Correspondence Andrea Stuart, Department of Obstetricsand Gynecology, Institute for Clinical Sciences, Lund University, Lund, Sweden. Email: [andrea.stuart@med.lu.se](andrea.stuart@med.lu.se) Abstract Introduction: The current standard treatment for endometrial cancer is a laparoscopic hysterectomy with adnexectomies and bilateral sentinel node resection. A retroperitoneal vNOTES sentinel node resection has several theoretical potential advantages. These include being less invasive, leaving no visible scars, operating without Trendelenburg, and therefore offering the anesthetic advantage of easier ventilation in obese patients and following the natural lymph node trajectory from caudally to cranially and therefore a lower risk of missing the sentinel node. The aim of this study is to determine the feasibility of a retroperitoneal vNOTES approach to sentinel lymph node dissection for staging of endometrial cancer. Material and methods: A prospective multicenter case series was performed in four hospitals. A total of 64 women with early-stage endometrial carcinoma suitable for surgical staging with sentinel lymph node removal were operated via a transvaginal retroperitoneal vNOTES approach. The paravesical space was entered through a vaginal incision after injecting the cervix with indocyanine green. A vNOTES port was placed into this space and insufflation of the retroperitoneum was performed. Sentinel lymph nodes were identified bilaterally using near-infrared light followed by endoscopic removal of these nodes. Results: A total of 64 women with early-stage endometrial cancer underwent sentinel lymph node removal by retroperitoneal vNOTES technique. All patients also underwent subsequent vNOTES hysterectomy and bilateral salpingo-oophorectomy. The median age was 69.5 years, median total operative time was 126 min and the median estimated blood loss was 80 mL. In 97% of the cases bilateral sentinel nodes could be identified. A total of 60 patients had negative sentinel nodes, three had isolated tumor cells and one had macroscopically positive sentinel nodes. No complications with sequel occurred. | Abbreviations: VD, vaginal delivery; vNOTES, vaginal natural orifice transluminal endoscopic surgery. | | --- | | This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2024 The Authors. Acta Obstetricia et Gynecologica Scandinavica publish

FAQs

What study objective was evaluated for endometrial cancer staging?

The study assessed feasibility of a retroperitoneal vNOTES approach for sentinel lymph node dissection in women undergoing staging for endometrial cancer.

How were sentinel lymph nodes identified and removed during the procedure?

After indocyanine green injection into the cervix, a vNOTES port was placed into the retroperitoneal space, and bilateral sentinel lymph nodes were identified using near-infrared light followed by endoscopic removal.

What were the key findings regarding sentinel node detection and pathology outcomes?

Bilateral sentinel nodes were identified in 97% of cases. Among 64 women, 60 had negative sentinel nodes, 3 had isolated tumor cells, and 1 had macroscopically positive sentinel nodes, with no reported sequelae complications.

Sep 21, 2026

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