Comparison of Robotic and Natural Orifice Transluminal Endoscopic Surgical Technique Procedures in Patients Undergoing Sentinel Lymph Node Biopsy During Endometrial Cancer Surgery

Abstract

Objective: The role of sentinel lymph node dissection in the surgical management of endometrial cancer limited to the uterus is gaining recognition. The safety and applicability of two methods were assessed by examining the results of our patients in the identification of the sentinel lymph node during endometrial cancer surgery. The methods were robotic surgery, a critical component of minimally invasive surgery, and the vNOTES (Natural Orifice Transluminal Endoscopic Surgery Technique), which has recently been introduced for malignant indications. Methods: Patients who had endometrial cancer surgery at our center employing robotic and vNOTES technologies between January 2023 and June 2024 were included in this retrospective study. We conducted the dissection of sentinel lymph nodes utilizing a near-infrared technology camera method with indocyanine green (ICG) in both robotic and vNOTES techniques. The patients' records were retrospectively obtained from patient files and hospital records. Among the 76 patients who underwent surgery for endometrial cancer, 24 were treated with vNOTES surgery, whereas 52 received robotic surgery. Results: No statistically significant differences were seen between the two groups for age (p = 0.447), body mass index (p = 0.506), prior abdominal operations (p = 0.209), predicted blood loss (p = 0.155), and surgical duration (p = 0.298). The detection rates of sentinel lymph nodes (SLN) were similar across the groups: 97 % (n = 50) in the robotic group and 96 % (n = 23) in the vNOTES group (p = 0.493). The only statistically significant difference was observed in postoperative pain scores at the 12th hour, which were lower in the vNOTES group (p = 0.023). Conclusion: The vNOTES technique demonstrates comparable sentinel lymph node detection rates to robotic surgery in the management of uterine endometrial cancer. Moreover, it has the advantage of markedly less postoperative discomfort. vNOTES is a secure and efficacious minimally invasive option, especially for patients with comorbidities or those deemed unsuitable for robotic surgery. © 2025 Elsevier B.V., All rights reserved.