Sentinel Lymph Node Mapping with Indocyanine Green in Endometrial Cancer: Does the Minimally Invasive Platform Matter?

Abstract

Introduction: To compare indocyanine green (ICG) sentinel lymph node (SLN) mapping between conventional laparoscopy and robot-assisted surgery in apparent early-stage endometrial cancer.

Methods: Consecutive patients undergoing minimally invasive surgery with SLN mapping at the University of Naples Federico II between January 2023 and December 2024 were retrospectively analyzed. Intracervical ICG was injected according to a standardized protocol; reinjection and side-specific pelvic lymphadenectomy were performed in case of persistent mapping failure. All SLN specimens underwent ultrastaging. The primary endpoint was SLN detection (bilateral/unilateral/absent; any mapping). Multivariable logistic regression assessed any SLN mapping success, controlling for age, BMI, and diabetes. Adjusted median regression assessed the length of hospital stay using the same covariates.

Results: Overall, 169 patients were included (62 laparoscopic, 107 robotic). Any mapping was 90.3% vs 91.6% (p = 1.000) and the mapping pattern did not differ (global p = 0.718). After adjustment for age, BMI, and diabetes, robotic surgery was not independently associated with any SLN mapping success (adjusted OR 1.33, 95% CI 0.43-4.09; p = 0.618). Operative time and blood loss were comparable. LOS was shorter after robotics (30.0 [27.0-34.5] vs 49.0 [44.2-52.0] hours, p < 0.001) and remained significant after adjustment. Postoperative complications were rare (3.2% vs 0.9%, p = 0.555).

Discussion: In this retrospective cohort using a standardized ICG protocol with ultrastaging and predefined failure management, no statistically significant difference in SLN mapping performance was observed between laparoscopic and robot-assisted surgery. Robot-assisted surgery was associated with a shorter hospital stay.