PDF(Pubmed)
Abstract：
(1) Background: Sentinel lymph node (SLN) mapping represents an accurate and feasible technique for the surgical staging of endometrial and cervical cancer. This is commonly performed by conventional laparoscopy or robotic-assisted laparoscopy, but in recent years, a new retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach has been described and developed by Jan Baekelandt. This technique provides easy visualization of lymphatic afferent vessels and pelvic lymph nodes, early SLN assessment, and a coherent mapping methodology following the lymphatic flow from caudal to cranial. However, only a few publications have reported it. Following the IDEAL (Idea Development Exploration Assessment Long-term follow-up) framework, research concerning this technique is in Stage 2a, with only small case series as evidence of its feasibility. Its standardized description appears necessary to provide the surgical homogeneity required to move further. (2) Methods: Description of a standardized approach for retroperitoneal pelvic SLN mapping by vNOTES. (3) Results: We describe a 10-step approach to successfully perform retroperitoneal vNOTES SLN mapping, including pre-, intra-, and postoperative management. (4) Conclusions: This IDEAL Stage 2a study could help other surgeons approach this new technique, and it proposes a common methodology necessary for evolving through future IDEAL Stage 2b (multi-center studies) and Stage 3 (randomized controlled trials) studies.
摘要：
（1）背景：前哨淋巴结（SLN）标测代表了子宫内膜癌和宫颈癌手术分期的准确可行技术。这通常通过传统的腹腔镜检查或机器人辅助腹腔镜检查来完成，但近年来,JanBaekelandt描述并开发了一种新的腹膜后经阴道自然腔道内镜手术（vNOTES）方法。该技术提供了淋巴传入血管和盆腔淋巴结的简单可视化，早期SLN评估，以及从尾部到颅骨的淋巴流动后的连贯映射方法。然而,只有少数出版物报道过。遵循IDEAL（想法发展探索评估长期后续行动）框架，关于这项技术的研究处于阶段2a，只有小案例系列作为其可行性的证据。其标准化描述似乎有必要提供进一步移动所需的手术同质性。（2）方法：描述通过vNOTES进行腹膜后骨盆SLN标测的标准化方法。（3）结果：我们描述了一个成功执行腹膜后vNOTESSLN映射的10步方法，包括前，intra-,和术后管理。（4）结论：这个理想的2a期研究可以帮助其他外科医生采用这种新技术，它提出了一种共同的方法，该方法需要通过未来的IDEAL阶段2b（多中心研究）和阶段3（随机对照试验）研究来发展。
