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A step-by-step demonstration of laparoscopic sentinel lymph node mapping according to current guidelines

The locoregional metastatic or nonmetastatic status of related lymph nodes (LN), is critical to managing adjuvant therapy for most cancer patients. This is because the presence or absence of lymphatic metastases is essential for the accurate staging of the disease. The introduction of sentinel lymph node (SLN) biopsy was an important evolution in oncologic surgery. In endometrial cancer (EC) staging, SLN is now approved by European and National Comprehensive Cancer Network (NCCN) guidelines, even in highrisk diseases. 2 However, SLN procedures for EC have several limitations, including reliability, accuracy and potential procedurerelated complications. The risk of SLN complications is always present, but is most commonly related to technical issues due to a lack of experience. Common mistakes, especially at the early stages of the learning curve, include inadequate injection sites, removal of second/third level nodes, and/or empty nodes. 4 To overcome these difficulties, a surgical algorithm exists and is published in the NCCN. However, adherence to this algorithm may vary and these variations of surgical techniques potentially impact diagnostic accuracy and oncological outcomes. Figure 1 Lymphatics channels in obturator area, real image (A) and ICG image (B). The dissection technique consists of identifying the lymphatic channels in the lateral spaces and avoiding disturbing them in order to accurately target the sentinel lymph node.