Endoscopic inguinal sentinel node biopsy using indocyanine green in early-stage vulvar cancer: an innovative technique

Background. Minimally invasive lymphadenectomy is progressively emerging as an appealing strategy in patients with vulvar cancer, and at the same time, sentinel node biopsy is currently recognized as standard of care in patients with early-stage disease. Case presentation. The integration of minimally- invasive approaches and sentinel node biopsy appears as an intriguing horizon, and we present here the first endoscopic sentinel node biopsy using indocyanine green performed in a patient with early-stage vulvar cancer. Twenty-five mg of indocyanine green powder was diluted in 20 ml of injectable solution, and two ml of the solution were injected next to the vulvar lesion. After 10 minutes, the sentinel node was detected using a camera with Karl Storz near infrared system and removed using two ancillary 3 mm trocars. The sentinel node biopsy procedure duration was 25 minutes. Ipsilateral complete endoscopic inguino-femoral lymphadenectomy was then performed. The patient was discharged on post-operative day 1. At frozen section, and final histology one sentinel node was detected, and resulted negative for metastasis. No lymph-nodal metastases were detected in non-sentinel nodes. No surgical complications were observed, and 15 months after surgery the patient was free from disease. Conclusions. We present the first successful endoscopic inguinal sentinel node biopsy using Indocyanine green. Further studies are needed to clarify the feasibility and safeness of the procedure.