Detection and dissection of sentinel nodes in endometrial endometrioid cancer with indocyanine green using PinPoint laparoscopy: Analysis of the learning curve.

OBJECTIVE: Early-stage endometrial endometrioid adenocarcinoma is managed through laparoscopic total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Detection of positive nodes is rare, and lymphadenectomy may involve complications. Pelvic sentinel lymph node dissection can prevent complete dissection. Herein, we evaluated the learning curve of sentinel lymph node dissection using indocyanine green. STUDY DESIGN: All surgeries for endometrial endometrioid adenocarcinoma were performed laparoscopically with indocyanine green to detect sentinel nodes. The primary outcome was the ability to identify and resect sentinel lymph nodes on each side. The secondary outcome was correspondence between the frozen section histology of the nodes with the final histology. RESULTS: Among 31 patients with endometrial endometrioid adenocarcinoma treated between October 2018 and August 2020, 29 who underwent laparoscopy using indocyanine green were enrolled. Complete lymphadenectomy was performed in 16 patients. Failure to recognize sentinel nodes on right and left sides occurred in 10.34% and 0% of cases, respectively. The median number of recognized and dissected sentinel nodes was 1 on both sides (range 0-5). One patient had a lymph node positive for malignancy on histology (3.45%) on both sides. There were 13 and 14 cases of negative frozen sections on the right and left sides, respectively, and 1 case of a positive frozen section with positive whole pelvic lymph nodes. CONCLUSION: Sentinel node dissection using indocyanine green in endometrial endometrioid adenocarcinoma has a distinct learning curve; however, it is practical and achievable for skilled surgeons.

Transobturator vs single-incision suburethral mini-slings for treatment of female stress urinary incontinence: early postoperative pain and 3-year follow-up.

STUDY OBJECTIVE: To compare related pain and cure using the transobturator and single-incision suburethral mini-sling anti-incontinence operations. DESIGN: Open, prospective, nonrandomized 2-armed study comparing 2 surgical procedures for treatment of female stress urinary incontinence (Canadian Task Force classification II-1). SETTING: A university and a private hospital. PATIENTS: One hundred sixty-two women with stress urinary incontinence underwent either a tension-free vaginal tape-obturator (TVT-O) or a single-incision (TVT-SECUR) suburethral or mid-urethral tape operation. MEASUREMENTS AND MAIN RESULTS: Pain levels were estimated using a visual analog scale, and outcome using the Urinary Distress Inventory and the Incontinence Impact Questionnaire. Postoperative vaginal and thigh pain was transient, lasting for up to 2 weeks, and occurred significantly more frequently in the TVT-O group (32% vs 1% and 32% vs 0%, respectively). Dyspareunia was not self-limited, and occurred more frequently in the TVT-SECUR group (7.9% vs 0%). Cure rates were 86.9% in the TVT-O group and 90.9% in the TVT-SECUR group. Complication rates were similar in the 2 groups. CONCLUSION: Both procedures were effective, with few adverse effects. In sexually inactive patients, the TVT-SECUR procedure may be preferable because thigh and vaginal pain is largely averted with this procedure. Sexually active patients might be better referred for the TVT-O procedure because it was not followed by dyspareunia in our series. Patient choice of surgical method rather than randomization weakened the strength of this study.