Hélder Ferreira, MD, Cristina Nogueira-Silva, MD, PhD, Alice Miranda, DVM, Jorge Correia-Pinto, MD, PhD
Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal (all authors). ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, Portugal (all authors). Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal (Dr Ferreira). Department of Obstetrics and Gynecology, Hospital de Braga, Braga, Portugal (Dr Nogueira-Silva). Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal (Dr Correia-Pinto).
Background: The sentinel lymph node (SLN) concept might minimize surgical aggressiveness in gynecological oncology, namely in cervical and endometrial malignancies. Therefore, we assessed the feasibility of SLN identification, dissection, and harvesting by using minilaparoscopic surgical instruments in an animal model. We compared the minilaparoscopic approach, which is known to bring important advantages, with the use of conventional laparoscopic instruments.
Methods: Two groups of 7 female pigs were enrolled in this experiment that was performed by the same surgical team. In group A, all animals were approached by a similar minilaparoscopic surgical instrumentation, namely a 5-mm 30° endoscope (supraumbilical port) and 3 ancillary 3.5-mm trocars. In group B, a 5-mm conventional laparoscopic instrument set was used. The patent blue (4.0 mL) was injected on the paracervical region. The time for SLN coloring, identification, localization, dissection, and excision, as well as complications were recorded. The sealing of the lymphatic vessels was observed in the 2 groups. During this experiment, and for the both groups, the Trendelenburg position was kept the same, as well as the carbon dioxide–pneumoperitoneum pressure. Finally, a laparotomy was then performed to evaluate whether any stained SLN still remained.
Results: All endoscopic procedures were performed without major complications. SLN were identified and excised in all animals in both groups. The SLN localization varied between animals from external iliac to preaortic regions. The surgical times, from skin incision to SLN removal, was 28.4 ± 5.6 minutes for minilaparoscopy and 25.3 ± 6.8 minutes for conventional laparoscopy (P=.36). In group B, 1 stained SLN remained and was only detected by laparotomy.
Conclusions: We confirmed the feasibility of the minilaparoscopic surgical approach for identification, dissection, and excision of SLN, as well as for sealing the lymphatic vessels that supply the nodes. This procedure might be considered a potentially better alternative to reduce morbidity during staging procedures for gynecological malignancies.
Key Words: Gynecology, Instrumentation, Malignancy, Minilaparoscopy, Sentinel lymph node, Surgery