[Application of robot-assisted laparoscopic sentinel lymph node tracing in treating endometrial carcinoma].

Objective: To investigate the value of robot-assisted laparoscopic indocyanine green sentinel lymph node (SLN) tracing in treating endometrial carcinoma. Methods: Thirty-two patients with early-staging endometrial carcinoma were operated with laparoscopic comprehensive staging laparotomy from January 2019 to December 2021. At the same time, the SLN detection was performed by near-infrared fluorescence imaging tracer technology, in which the tracer was indocyanine green. Sixteen cases were injected with indocyanine green before laparoscopic surgery, and 16 cases were injected with indocyanine green before robot-assisted laparoscopic surgery. The operation index, postoperative complications, prognosis, and lymph node dissection were compared between the two groups. Results: (1) The mean age of patients in the robot group was (54.7±8.1) years old, and was (54.9±8.8) years old in the laparoscopic group. There were no significant difference between the two groups (t=0.06, P=0.951). (2) Intraoperative blood loss [(131±40) vs (169±57) ml], hemoglobin difference before and after surgery [(11.2±5.4) vs (15.5±5.7) g/L], the length of stay after operation [(6.2±1.3) vs (8.6±1.4) days] between the robot group and the laparoscopic group were compared, and the differences were statistically significant (all P<0.05). (3) SLNs were detected in all 16 patients in the robotic group, and a total of 41 SLNs were detected. SLNs were detected in 15 of the 16 patients in the laparoscopy group, and a total of 40 SLNs were detected. Compared with the laparoscopic group (15/16), the total detection rate of SLN in the robotic group (16/16), there were no statistical significance (χ2=1.03, P=0.310). Compared with the laparoscopic group (7/15), the SLN bilateral detection rate in the robotic group (10/16), there were also no significant difference (χ2=0.78, P=0.376). The number of lymph nodes detected in surgery group (16.6±4.1) were lower than those in the laparoscopy surgery group (21.0±7.1), while there were no statistically difference between the two groups (χ2=2.01, P=0.054). There was no tumor metastasis in the resected lymph nodes and SLN between the two groups. The false negative rate of SLN in diagnosing endometrial cancer postoperative lymph node metastasis was 0, and the negative predictive value was 100%. (4) The pelvic and retroperitoneal lymph nodes were divided into five regions, which were the left pelvis, the right pelvis, the presacral region, the deep inguinal region, and the abdominal aorta. The numbers of SLN of unilateral detection and bilateral pelvic detection between two groups showed no significant differences (all P>0.05). The left pelvis had the most SLN imaging in both groups, followed by the right pelvis, para-aortic, and deep groin. (5) There was one patient in both robotic group and laparoscopic group with postoperative complications, which were urinary retention and pelvic lymph node cyst respectively. There were no significant differences in the incidence of complications between the two groups (χ2=0.97, P=1.000). The median follow-up time after operation was 14 months (range 6-24 months). During the follow-up period, no local recurrence or distant metastasis was found between the two groups of endometrial cancer patients. Conclusions: Compared with the laparoscopic group, the robot group has less intraoperative blood loss and shorter postoperative hospital stay. The bilateral detection rate of SLN in the group was better than that of laparoscopy.目的： 探讨机器人辅助腹腔镜联合前哨淋巴结（SLN）近红外荧光成像示踪技术在子宫内膜癌手术中的应用价值。 方法： 回顾性分析2019年1月至2021年12月武汉大学中南医院收治的行腹腔镜全面分期手术且术前采用近红外荧光成像示踪技术（示踪剂为吲哚菁绿）行SLN检测的32例早期（Ⅰ、Ⅱ期）子宫内膜癌患者的临床病理资料，其中16例行传统腹腔镜手术（腹腔镜组），16例行机器人辅助腹腔镜手术（机器人组）；对两组患者的手术相关指标、SLN检出情况、SLN的分布、手术并发症及预后进行比较。 结果： （1）机器人组患者的年龄、体质指数、病理类型、病理分级、手术病理分期分别比较，差异均无统计学意义（P均>0.05）。（2）机器人组、腹腔镜组患者的术中出血量［分别为（131±40）、（169±57）ml］、手术前后血红蛋白差值［分别为（11.2±5.4）、（15.5±5.7）g/L］、术后住院时间［分别为（6.2±1.3）、（8.6±1.4）d］分别比较，差异均有统计学意义（P均<0.05）。（3）机器人组16例患者均检测到SLN，共检出SLN 41枚；腹腔镜组16例患者中15例检测到SLN，共检出SLN 40枚。机器人组患者的SLN总检出率（16/16）与腹腔镜组（15/16）比较，差异无统计学意义（χ2=1.03，P=0.310）；机器人组SLN双侧检出率（10/16）与腹腔镜组（7/15）比较，差异无统计学意义（χ2=0.78，P=0.376）。机器人组每例患者切除淋巴结数为（16.6±4.1）枚，与腹腔镜组［（21.0±7.1）枚］比较，差异无统计学意义（χ2=2.01，P=0.054）。两组患者切除的淋巴结及SLN术后病理检查均无肿瘤转移，SLN诊断子宫内膜癌术后淋巴结转移的假阴性率均为0，阴性预测值均为100%。（4）将盆腔及腹膜后淋巴结划分为左侧盆腔、右侧盆腔、骶前区、腹股沟深、腹主动脉旁共5个区域。机器人组单个区域SLN显影6例（12枚），多个区域SLN显影10例（29枚），腹腔镜组单个区域SLN显影7例（14枚），多个区域SLN显影8例（26枚）。两组患者的SLN显影均以左侧盆腔最多，其次均为右侧盆腔、腹主动脉旁、腹股沟深。（5）机器人组、腹腔镜组均有1例患者出现术后并发症，分别为尿潴留、盆腔淋巴囊肿，两组并发症发生率（均为1/16）比较，差异无统计学意义（χ2=0.97，P=1.000）。术后中位随访时间为14个月（6~24个月），随访期内两组子宫内膜癌患者均未发现局部复发或远处转移。 结论： 对于Ⅰ、Ⅱ期早期子宫内膜癌患者，与腹腔镜组相比，机器人组患者的术中出血量更少、术后住院时间更短，同时SLN双侧检出率较高。.