Robotic laparoendoscopic single site radical hysterectomy with sentinel lymph node mapping and pelvic lymphadenectomy for cervical cancer

Objective. Laparoendoscopic single site (LESS) radical hysterectomy has been previously described but has not gained wide acceptance [1,2]. The role of sentinel lymph node (SLN) mapping in cervical cancer continues to evolve [3]. Recent advances in the single site robotic platform have made the performance of robotic LESS radical hysterectomy feasible [4]. The aim of this video is to demonstrate the feasibility of robotic LESS radical hysterectomy, with sentinel lymph node mapping and complete lymphadenectomy. Methods. The patient was a 50 year old with stage 1B1 cervical carcinoma. Body mass index was 31 kg/m₂ and the uterus was 8 cm on bimanual exam. After cervical injection of indocayanin green, the patient underwent SLN biopsy, type III radical hysterectomy and pelvic lymphadenectomy utilizing the daVinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) through a single multichannel port, inserted through the umbilicus. A full pelvic lymphadenectomy was then performed and the lymph nodes were retrieved with an endocatch bag inserted thorough the vaginotomy. The vagina was closed with a running V-lock suture in two layers. Results. Bilateral hypogastric SLN was identified. Total operative time was 320 min and estimated blood loss was 200 mL. The patient was discharged home on postoperative day 1 and no complications were noted. Final pathology revealed a poorly differentiated cervical carcinoma with 100% stromal invasion, negative margins, and no lymph-vascular space invasion. Sentinel (n = 4) and pelvic (n = 15) lymph nodes were negative. Conclusion. Robotic LESS radical hysterectomy with SLN mapping and pelvic lymphadenectomy is feasible. Ideal candidates for this procedure are patients with small tumors (<2 cm), small uteri (< 10 cm) and minimal prior complex pelvic surgery. Increased surgeon and assistant experience, and the use of smoke evacuator devices significantly decrease operative time.