2022-RA-1155-ESGO Feasibility of hand assisted laparoscopic sentinel node biopsy in vulvar cancer using combined radioactive and fluorescence guidance

Introduction/Background: The aim of this preliminary retrospective study was to assess the feasibility and accuracy of Indocyanine Green (ICG) sentinel lymph node (SLN) sampling using a laparoscopic camera during vulvar cancer staging. Methodology: Retrospective study. Between 2016 and 2022, 9 women with diagnosis of vulvar cancer underwent radical vulvectomy and inguinofemoral lymphadenectomy; in 2 (22%) selected cases we performed ICG SLN mapping using the IMAGE1 laparoscopic camera combining with Tc99(m)-nanocolloid during open surgery. Results: The median age of patients was 73 (range 84–60) years. Mean operative time 212.5 minutes. The overall detection rate of SLN mapping was 100%. No post-operative short or long-term complications related to the procedure were observed. Conclusion: Real-time NIR technology supported by the IMAGE1 S by Storz is a reliable system and represents a consolidated method for SLN mapping in selected cases with vulvar cancer. In our study we confirmed the feasibility of Hand-Assisted Laparoscopy during an open procedure to detect groin SLN with ICG in vulvar cancer. This approach can be used in combination with Tc99(m)-nanocolloid, increasing the detection rate or it can be an appropriate option to detect SLN in those countries where Tc99(m)-nanocolloid is not available or cannot be practiced. The use of laparoscopic camera for ICG SLN mapping seems to be accessible and inexpensive. Further studies are needed to evaluate the accuracy and oncological outcomes.