Technique of ICG-guided Targeted Compartmental Pelvic Lymphadenectomy (TCL) combined with Pelvic Peritoneal Mesometrial Resection (PMMR) for locoregional control of endometrial cancer - A proposal.

•PMMR is a compartment based radical hysterectomy in endometrial cancer.•Pelvic PMMR may be combined with ICG guided Targeted Compartmental Lymphadenectomy (TCL).•Video of Pelvic PMMR and TCL technique may be basis for a prospective study.

Lymphatic network of the uterus can be visualized by intracorporal injection of indocyanine green (ICG) as guide in compartmental surgery (Kimmig et al., 2016a, Kimmig et al., 2016b). Compartmental surgery may be able to effectively control for locoregional tumour recurrence and reducing perioperative complications at the same time by resecting the tumour within the borders of the corresponding morphogenetic fields (Höckel, 2015, Höckel et al., 2009, Santiago et al., 2016). There is first evidence, that this may hold true also for endometrial cancer in intermediate/high risk endometrial cancer (Kimmig et al., 2015). However, the systematic lymphadenectomy increases morbidity; as a consequence diagnostic sentinel node biopsy was investigated; there is evidence that the accuracy of detection of positive nodes is excellent with a very low false negative rate also with respect to paraaortic disease (Zahl Eriksson et al., 2016, Darin et al., 2016, Sinno et al., 2016, Tschernichovsky et al., 2016, Ruscito et al., 2016). Thus, performing a resection of the tumour bearing compartment “en bloc” together with the lymphatic network including the sentinel nodes, it may be suggested that this surgery may be able to control for locoregional recurrence in the pelvis up to the pelvic nodes resected (therapeutically) comparable to (Kimmig et al., 2015) and indicates further need of treatment downstream to these nodes in node positive disease (diagnostically).

The video defines the technique of “en bloc” resection of the uterus together with its corresponding embryonal compartment (pelvic PMMR) and part for the first draining lymph compartments containing the sentinel nodes (TCL). This will be basis for an international multicenter study under consideration to evaluate the locoregional control of this procedure without additional adjuvant irradiation; systematic pelvic and paraaortic lymphadenectomy will be added in case of node positive disease.

The following is the supplementary data related to this article.

Supplementary video 1

ICG guided targeted compartmental pelvic lymphadenectomy (TCL)

Supplementary data to this article can be found online at http://dx.doi.org/10.1016/j.gore.2017.04.002.