Gynecological Oncology

Gynecological Oncology is a major focus area for Olympus providing gynecologists and patients with minimally invasive solutions.​

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Sentinel Lymph Node Dissection

Sentinel Lymph Node Dissection
Different from systematic lymphadenectomy, the sentinel node biopsy offers a less radical variant for the lymph node staging in the pelvis. Sentinel node biopsy has been suggested for early-stage endometrial and cervical cancer. 1
After opening the peritoneum and developing the paravesical and pararectal spaces the sentinel node will be identified by visual inspection of the lymphatic tissue covering the iliac vessels and consequently dissected and excised.

* Legally, ICG has not been approved for intracervical injection, however the usage is widely spread and its clinical efficacy has been demonstrated in many scientific studies.

Indocyanine Green (ICG) for Sentinel Lymph Node Mapping

Evidence 2 has shown that Near Infrared (NIR) indocyanine green (ICG) yields the highest bilateral SLN detection rates (88-95.5%). 3
Its ease of use means that a reliable diagnosis can be provided along with major time savings: SLN mapping is immediate and no longer needs to be prepared in advance.

Near Infrared Imaging Benefits during Sentinel Lymph Node Dissection

The possibility to easily change from the infrared (IR) mode to conventional white light mode allows the surgeon to confidently dissect the lymph nodes without injuring the adjacent blood vessels.

Nerve-sparing Laparoscopic Hysterectomy

Safety through Advanced Hemostasis

In pelvic and para-aortic lymphadenectomy as well as in omentectomy, the surgeon works in an area containing numerous large blood vessels and nerves, but also very close to critical organs. 4 5 A safe energy device with advanced hemostasis is therefore needed — one that coagulates efficiently and ensures minimal thermal spread. 6 7 8 9 10

Reducing the Operating Time

Moreover, safe surgery for the patient means reducing the operating time as much as possible and allowing for precise dissection. THUNDERBEAT Type S combines all these demanding requirements for oncological surgeries and provides the surgeon with peace of mind. 11 12 13 14 15

THUNDERBEAT Type S Details

3D Imaging in Laparoscopic Hysterectomy

The dissection during laparoscopic hysterectomy needs to respect oncological rules and at the same time avoid accidental injuries of the vascular and lymphatic structures. Delicate and precise movements are therefore crucial. 4 5

3D vision provides the surgeon with depth perception and therefore facilitates a quicker and safer identification of the correct planes and structures.

Advantages of 3D Imaging

In this way, the movements of the surgeon are much more precise and accidental injuries can be avoided — the surgeon is able to measure the distances between anatomical structures far better. This advantage is especially beneficial:

  • In pelvic and para-aoaortic lymphadenectomy, where the high risk of hemorrhage due to a huge amount of very small vessels decreases significantly.
  • For a nerve-sparing dissection of the paravesical and pararectal spaces, which decreases the incidence of post-operative collateral effects.
  • For the preparation of the vesicovaginal space, in order to identify the correct level of dissection depth. 16 17 18 19 20 21 22 23 24 25 26

Achieving High-Quality Surgery

The laparoscopic endoscope ENDOEYE 3D* provides the surgeon with a depth perception that supports them in achieving a high-quality surgery and additionally

  • Saves operating time.
  • Achieves improved confidence during procedures.
  • Reduces the laparoscopic learning curve.

ENDOEYE 3D Product Details

Laparoscopic Trachelectomy

Precision, Efficiency and Safety During Laparoscopy with Hybrid Technology

  • The transection of the uterine arteries at their origin, meeting the principles of radicality.
  • The dissection of the ureter, removing it from the total extension of the parametrium until its entrance into the bladder

Both surgical steps in laparoscopic trachelectomy require a precise, fast and safe energy device. THUNDERBEAT combines all these requirements by providing the surgeon hybrid energy: Simultaneous advanced bipolar and ultrasound energy for fast cutting as well as advanced bipolar energy only for safe vessel sealing at minimal thermal spread. 11 12 13 14 15

Fine Tip for Precise Dissection

As the fine tip of the curved jaw supports the surgeon with a precise dissection, THUNDERBEAT is ideal for the dissection of the:

  • Pararectal spaces.
  • Mobilization of the rectum.
  • Rectovaginal spaces.
  • Lateral and posterior parametria at their origins.

Cervical amputation can be performed efficiently and in a blood-dry manner with THUNDERBEAT. Hybrid technology is once again the solution for a fast and safe laparoscopic procedure.

THUNDERBEAT Product Details

Simple Laparoscopic Suturing Thanks to 3D Imaging

Especially for the uterovaginal anastomosis, 3D imaging supports the surgeon during the suturing due to the depth perception. But also for the prior dissection steps, 3D imaging provides a better view of the distances between anatomical structures.

Gynecological Cancer Diagnosis with Narrow Band Imaging (NBI)

High-Resolution NBI in Gynecological Oncology

High-resolution narrow band imaging endoscopy (NBI) detection of malignomas, such as colorectal neoplasia, has been reported to improve tumor diagnosis in several medical disciplines. 27 28 29

By revealing their characteristic surface staining or vascular pattern, NBI endoscopy allows significant improvements in:

  • Tumor detection of very small lesions.
  • Occult lesions.

Before
After

Endometrial Cancer

The incidence of endometrial cancer (main type of uterine cancer) has increased by 21% since 2008 30 31 32 33 35.
Lymph node dissection (LND) is an important step in the surgical management of endometrial cancers. However, it can also contribute to complications.

Sentinel lymph node (SLN) mapping has gained increasing acceptance for staging of gynecological malignancy. Clinical evidence has shown that sentinel node mapping is an accurate and feasible method that performs well diagnostically for the assessment of lymph nodal involvement in endometrial cancer. According to clinical studies, patients who underwent SLN mapping had less pelvic/nodal recurrences compared to LND alone. Negative node patients with additional SLN mapping had superior oncological outcomes. Utilizing indocyanine green resulted in the highest SLN detection rates.

Ovarian Cancer

Ovarian cancer is the second most common malignancy after breast cancer in women over the age of 40, particularly in developed countries. 36 37 38
Thereby, for patients with clinical stageIII ovarian cancer, clinical evidence has shown that a sentinel lymph node procedure performed through the injection of tracers into the ovarian ligaments is feasible.

The overall detection rate is of 90.3%.

Cervical Cancer

Cervical cancer is the second most common malignancy of the female genital tract worldwide. Radical hysterectomy is one of the standard cervical cancer treatments for stage Ia2 to IIa cervical cancer, however it can be associated with complications.

Nervesparing radical hysterectomy (NSRH) is a technique in which the neural part of the cardinal ligament remains intact. The neural part of the cardinal ligament encloses the inferior hypogastric plexus and the bladder branch (distal part of the plexus). This way, the bladder’s innervation is safe and its functional recovery is more rapid. 39 40

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Sources​

  1. 1.Lymphatic map- ping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy. Levenback C, Coleman RL, Burke TW, et al. J Clin Oncol. 2002;20:688–93.
  2. 2.Indocyanine green and infrared fluorescence in detection of sentinel lymph nodes in endometrial and cervical cancer staging - a systematic review.

    Impact of Indocyanine Green for Sentinel Lymph Node Mapping in Early Stage Endometrial and Cervical Cancer: Comparison with Conventional Radiotracer (99m)Tc and/or Blue Dye.
    Rocha A, Domínguez AM, Lécuru F, Bourdel N.

    Buda A, Crivellaro C, Elisei F, Di Martino G, Guerra L, De Ponti E, Cuzzocrea M, Giuliani D, Sina F, Magni S, Landoni C, Milani R.
    Eur J Obstet Gynecol Reprod Biol. 2016 Nov;206:213-219. doi: 10.1016/j.ejogrb.2016.09.027. Epub 2016 Sep 30. PMID: 27750179.

    Ann Surg Oncol. 2016 Jul;23(7):2183-91. doi: 10.1245/s10434-015-5022-1. Epub 2015 Dec 29. PMID: 26714944; PMCID: PMC4889617.
  3. 3.Compared with 99Tc/blue dye combination (61%) and methylene blue alone (50%)
  4. 4.Anatomic Cartography of the Hypogastric Nerves and Surgical Insights for Autonomic Preservation during Radical Pelvic Procedures. Seracchioli R, Mabrouk M, Mastronardi M, Raimondo D, Arena A, Forno SD, Mariani GA, Billi AM, Manzoli L, O'Guin WM, Lemos N.J Minim Invasive Gynecol. 2019 Jan 29
  5. 5.Laparoscopic nerve-sparing radical hysterectomy: Description of the technique and patients’ outcome. Kavallaris A, Hornemann A, Chalvatzas N, Luedders D, Diedrich K, Bohlmann MK. Gynecol Oncol 2010;119(2):198–201.
  6. 6.Randomized Study Comparing Use of THUNDERBEAT Technology vs Standard Electrosurgery during Laparoscopic Radical Hysterectomy and Pelvic Lymphadenectomy for Gynecologic Cancer. 2014 May/June. Fagotti, A., Vizielli, G., Fanfani, F., Gallotta, V., Rossitto, C., Costantini, B., Gueli-Alletti, S., Avenia, N., Iodice, R., Scambia, G. The Journal of Minimally Invasive Gynecology, Volume 21, Issue 3, Pages 447–453.
  7. 7.Minilaparoscopic hysterectomy made easy: First report on alternative instrumentation and new integrated energy platform. Ng, Ying & Lim, Li & Fong, Yoke. (2014). Journal of Obstetrics and Gynaecology Research. 40. 10.1111/jog.12354.
  8. 8.Efficacy and Safety of Combined Ultrasonic and Bipolar Energy Source in Laparoscopic Surgery. Steinemann, Daniel & Lamm, Sebastian & Zerz, Andreas. (2016). Journal of Gastrointestinal Surgery. 20. 10.1007/s11605-016-3217-9.
  9. 9.Evaluation of Vessel Sealing Performance among Ultrasonic Devices in a Porcine Model. Tanaka et al. Surg Innov. 2015 Aug;22(4):338-43. doi: 10.1177/1553350615579730. Epub 2015 Apr 7.
  10. 10.Application of a New Integrated Bipolar and Ultrasonic Energy Device in Laparoscopic Hysterectomies. Lin et al. ISRN Minimally Invasive Surgery (2013)
  11. 11.Randomized Study Comparing Use of THUNDERBEAT Technology vs Standard Electrosurgery during Laparoscopic Radical Hysterectomy and Pelvic Lymphadenectomy for Gynecologic Cancer. Fagotti, A., Vizielli, G., Fanfani, F., Gallotta, V., Rossitto, C., Costantini, B., Gueli-Alletti, S., Avenia, N., Iodice, R., Scambia, G., 2014 May/June. The Journal of Minimally Invasive Gynecology, Volume 21, Issue 3, Pages 447–453.
  12. 12.Minilaparoscopic hysterectomy made easy: First report on alternative instrumentation and new integrated energy platform. Ng, Ying & Lim, Li & Fong, Yoke. (2014). Journal of Obstetrics and Gynaecology Research. 40. 10.1111/jog.12354.
  13. 13.Efficacy and Safety of Combined Ultrasonic and Bipolar Energy Source in Laparoscopic Surgery. Steinemann, Daniel & Lamm, Sebastian & Zerz, Andreas. (2016). Journal of Gastrointestinal Surgery. 20. 10.1007/s11605-016-3217-9.
  14. 14.Evaluation of Vessel Sealing Performance among Ultrasonic Devices in a Porcine Model. Tanaka et al. Surg Innov. 2015 Aug;22(4):338-43. doi: 10.1177/1553350615579730. Epub 2015 Apr 7.
  15. 15.Application of a New Integrated Bipolar and Ultrasonic Energy Device in Laparoscopic Hysterectomies. Lin et al. ISRN Minimally Invasive Surgery (2013)
  16. 16.Three-dimensional (3D) vision: does it improve laparoscopic skills? Bhayani SB, Andriole GL (2005) An assessment of a 3D headmounted visualization system. Rev Urol 7:211–214
  17. 17.Comparative study of various 2-D and 3-D vision systems in minimally invasive surgery. Buess GF, van Bergen P, Kunert W, Schurr MO (1996) Chirurg 67:1041–1046
  18. 18.Comparison of two-dimensional vs three-dimensional camera systems in laparoscopic surgery. Chan AC, Chung SC, Yim AP, Lau JY, Ng EK, Li AK (1997) Surg Endosc 11:438–440
  19. 19.Visual integration of data and basic motor skills under laparoscopy: influence of 2-D and 3-D videocamera systems. Dion YM, Gaillard F (1997) Surg Endosc 11:995–1000
  20. 20.Influence of two-dimensional and three-dimensional imaging on endoscopic bowel suturing. Hanna GB, Cuschieri A (2000) World J Surg 24:444–448 discussion 448–449
  21. 21.The influence of threedimensional video systems on laparoscopic task performance. Jones DB, Brewer JD, Soper NJ (1996) Surg Laparosc Endosc6:191–197
  22. 22.Comparison of three-dimensional and twodimensional laparoscopic video systems. J Endourol 10:371–374 McDougall EM, Soble JJ, Wolf JS Jr, Nakada SY, Elashry OM, Clayman RV (1996)
  23. 23.A prospective randomized experimental evaluation of three-dimensional imaging in laparoscopy. Peitgen K, Walz MV, Walz MV, Holtmann G, Eigler FW (1996) Gastrointest Endosc 44:262–267
  24. 24.Threedimensional versus two-dimensional video system for the trained endoscopic surgeon and the beginner. Pietrabissa A, Scarcello E, Carobbi A, Mosca F (1994) Endosc Surg Allied Technol 2: 315–317
  25. 25.The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons. Taffinder N, Smith SG, Huber J, Russell RC, Darzi A (1999) Surg Endosc 13: 1087–1092
  26. 26.Comparative study of two dimensional and three-dimensional vision systems for minimally invasive surgery. Van Bergen P, Kunert W, Bessell J, Buess GF (1998) Surg Endosc 12:948–954
  27. 27.Narrow band imaging in borderline ovarian tumor [published correction appears in J Minim Invasive Gynecol. Fanfani F, Gallotta V, Rossitto C, Fagotti A, Scambia G. 2010 Jul-Aug;17(4):539]. J Minim Invasive Gynecol. 2010;17(2):146-147. doi:10.1016/j.jmig.2009.04.001
  28. 28.Narrow-band imaging in laparoscopic management of recurrent platinum sensitive ovarian cancer. Gagliardi ML, Polito S, Fagotti A, Fanfani F, Scambia G. J Minim Invasive Gynecol. 2013;20(1):10-12. doi:10.1016/j.jmig.2012.01.016
  29. 29.Narrow-band imaging in diagnosis of endometrial cancer and hyperplasia: a new option? Surico D, Vigone A, Bonvini D, Tinelli R, Leo L, Surico N. J Minim Invasive Gynecol. 2010;17(5):620-625. doi:10.1016/j.jmig.2009.10.014
  30. 30.Endometrial cancer. Sorosky JI. Obstet Gynecol. 2012;120(2 Pt 1):383-397. doi:10.1097/AOG.0b013e3182605bf1
  31. 31.Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment. Onstad MA, Schmandt RE, Lu KH. J Clin Oncol. 2016;34(35):4225-4230.doi:10.1200/JCO.2016.69.4638
  32. 32.Management of Endometrial Cancer: A Review. Suri V, Arora A. Rev Recent Clin Trials. 2015;10(4):309-316.doi:10.2174/1574887110666150 923115228
  33. 33.Meta-analysis of laparoscopy sentinel lymph node mapping in endometrial cancer. Wang L, Liu F. Arch Gynecol Obstet. 2018;298(3):505-510.doi:10.1007/s00404-018-4845-y
  34. 34.Sentinel lymph node mapping in endometrial cancer: a systematic review and metaanalysis. How JA, O'Farrell P, Amajoud Z, et al. Minerva Ginecol. 2018;70(2):194-214.doi:10.23736/S0026-4784.17.04179-X
  35. 35.The added value of sentinel node mapping in endometrial cancer. Kogan L, Matanes E, Wissing M, et al. Gynecol Oncol. 2020;158(1):84-91.doi:10.1016/j.ygyno.2020.04.687
  36. 36.Ovarian Cancer: An Integrated Review. Stewart C, Ralyea C, Lockwood S. Semin Oncol Nurs. 2019;35(2):151-156.doi:10.1016/j.soncn. 2019.02.001).
  37. 37.The detection of sentinel nodes in ovarian cancer: a feasibility study. Kleppe M, Brans B, Van Gorp T, et al. J Nucl Med. 2014;55(11):1799-1804.doi:10.2967/jnumed.114.144329
  38. 38.Feasibility of sentinel lymph node mapping of the ovary: a systematic review. Dell'Orto F, Laven P, Delle Marchette M, Lambrechts S, Kruitwagen R, Buda A. Int J Gynecol Cancer. 2019;29(7):1209-1215.doi:10.1136/ijgc-2019-000606
  39. 39.Nerve sparing radical hysterectomy in early stage cervical cancer. Kavallaris A, Zygouris D, Dafopoulos A, Kalogiannidis I, Terzakis E. Latest developments and review of the literature. Eur J Gynaecol Oncol. 2015;36(1):5-9.
  40. 40.Nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa). Kietpeerakool C, Aue-Aungkul A, Galaal K, Ngamjarus C, Lumbiganon P. Cochrane Database Syst Rev. 2019;2(2):CD012828. Published 2019 Feb 12. doi:10.1002/14651858. CD012828.pub2

1. Levenback C, Coleman RL, Burke TW, et al. Lymphatic map- ping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy. J Clin Oncol. 2002;20:688–93. ​
2. Rocha (2016), Buda (2016), Buda (2015), Imboden (2015)​
3. Compared with 99Tc/blue dye combination (61%) and methylene blue alone (50%)​
4. Anatomic Cartography of the Hypogastric Nerves and Surgical Insights for Autonomic Preservation during Radical Pelvic Procedures. Seracchioli R, Mabrouk M, Mastronardi M, Raimondo D, Arena A, Forno SD, Mariani GA, Billi AM, Manzoli L, O'Guin WM, Lemos N.J Minim Invasive Gynecol. 2019 Jan 29​
5. Kavallaris A, Hornemann A, Chalvatzas N, Luedders D, Diedrich K, Bohlmann MK. Laparoscopic nerve-sparing radical hysterectomy: Description of the technique and patients’ outcome. Gynecol Oncol 2010;119(2):198–201. ​
6. Fagotti, A., Vizielli, G., Fanfani, F., Gallotta, V., Rossitto, C., Costantini, B., Gueli-Alletti, S., Avenia, N., Iodice, R., Scambia, G., Randomized Study Comparing Use of THUNDERBEAT Technology vs Standard Electrosurgery during Laparoscopic Radical Hysterectomy and Pelvic Lymphadenectomy for Gynecologic Cancer. 2014 May/June. The Journal of Minimally Invasive Gynecology, Volume 21, Issue 3, Pages 447–453.​
7. Ng, Ying & Lim, Li & Fong, Yoke. (2014). Minilaparoscopic hysterectomy made easy: First report on alternative instrumentation and new integrated energy platform. Journal of Obstetrics and Gynaecology Research. 40. 10.1111/jog.12354.
8. Steinemann, Daniel & Lamm, Sebastian & Zerz, Andreas. (2016). Efficacy and Safety of Combined Ultrasonic and Bipolar Energy Source in Laparoscopic Surgery. Journal of Gastrointestinal Surgery. 20. 10.1007/s11605-016-3217-9. ​
9. Tanaka et al. Evaluation of Vessel Sealing Performance among Ultrasonic Devices in a Porcine Model. Surg Innov. 2015 Aug;22(4):338-43. doi: 10.1177/1553350615579730. Epub 2015 Apr 7.​
10. Lin et al. Application of a New Integrated Bipolar and Ultrasonic Energy Device in Laparoscopic Hysterectomies. ISRN Minimally Invasive Surgery (2013)
11. Fagotti, A., Vizielli, G., Fanfani, F., Gallotta, V., Rossitto, C., Costantini, B., Gueli-Alletti, S., Avenia, N., Iodice, R., Scambia, G., Randomized Study Comparing Use of THUNDERBEAT Technology vs Standard Electrosurgery during Laparoscopic Radical Hysterectomy and Pelvic Lymphadenectomy for Gynecologic Cancer. 2014 May/June. The Journal of Minimally Invasive Gynecology, Volume 21, Issue 3, Pages 447–453.​
12. Ng, Ying & Lim, Li & Fong, Yoke. (2014). Minilaparoscopic hysterectomy made easy: First report on alternative instrumentation and new integrated energy platform. Journal of Obstetrics and Gynaecology Research. 40. 10.1111/jog.12354. ​
13. Steinemann, Daniel & Lamm, Sebastian & Zerz, Andreas. (2016). Efficacy and Safety of Combined Ultrasonic and Bipolar Energy Source in Laparoscopic Surgery. Journal of Gastrointestinal Surgery. 20. 10.1007/s11605-016-3217-9. ​
14. Tanaka et al. Evaluation of Vessel Sealing Performance among Ultrasonic Devices in a Porcine Model. Surg Innov. 2015 Aug;22(4):338-43. doi: 10.1177/1553350615579730. Epub 2015 Apr 7.​
15. Lin et al. Application of a New Integrated Bipolar and Ultrasonic Energy Device in Laparoscopic Hysterectomies. ISRN Minimally Invasive Surgery (2013) ​
16. Bhayani SB, Andriole GL (2005) Three-dimensional (3D) vision: does it improve laparoscopic skills? An assessment of a 3D headmounted visualization system. Rev Urol 7:211–214​
17. Buess GF, van Bergen P, Kunert W, Schurr MO (1996) Comparative study of various 2-D and 3-D vision systems in minimally invasive surgery. Chirurg 67:1041–1046​
18. Chan AC, Chung SC, Yim AP, Lau JY, Ng EK, Li AK (1997)Comparison of two-dimensional vs three-dimensional camera systems in laparoscopic surgery. Surg Endosc 11:438–440​
19.Dion YM, Gaillard F (1997) Visual integration of data and basic motor skills under laparoscopy: influence of 2-D and 3-D videocamera systems. Surg Endosc 11:995–1000​
20. Hanna GB, Cuschieri A (2000) Influence of two-dimensional and three-dimensional imaging on endoscopic bowel suturing. World J Surg 24:444–448 discussion 448–449
21. Jones DB, Brewer JD, Soper NJ (1996) The influence of threedimensional video systems on laparoscopic task performance. Surg Laparosc Endosc 6:191–197​
22. McDougall EM, Soble JJ, Wolf JS Jr, Nakada SY, Elashry OM, Clayman RV (1996) Comparison of three-dimensional and twodimensional laparoscopic video systems. J Endourol 10:371–374​
23. Peitgen K, Walz MV, Walz MV, Holtmann G, Eigler FW (1996) A prospective randomized experimental evaluation of three-dimensional imaging in laparoscopy. Gastrointest Endosc 44:262–267​
24. Pietrabissa A, Scarcello E, Carobbi A, Mosca F (1994) Threedimensional versus two-dimensional video system for the trained endoscopic surgeon and the beginner. Endosc Surg Allied Technol 2: 315–317​
25. Taffinder N, Smith SG, Huber J, Russell RC, Darzi A (1999) The effect of a second-generation 3D endoscope on the laparoscopic precision of novices and experienced surgeons. Surg Endosc 13: 1087–1092​
26. van Bergen P, Kunert W, Bessell J, Buess GF (1998) Comparative study of two dimensional and three-dimensional vision systems for minimally invasive surgery. Surg Endosc 12:948–954​
27. Fanfani F, Gallotta V, Rossitto C, Fagotti A, Scambia G. Narrow band imaging in borderline ovarian tumor [published correction appears in J Minim Invasive Gynecol. 2010 Jul-Aug;17(4):539]. J Minim Invasive Gynecol. 2010;17(2):146-147. doi:10.1016/j.jmig.2009.04.001​
28. Gagliardi ML, Polito S, Fagotti A, Fanfani F, Scambia G. Narrow-band imaging in laparoscopic management of recurrent platinum sensitive ovarian cancer. J Minim Invasive Gynecol. 2013;20(1):10-12. doi:10.1016/j.jmig.2012.01.016​
29. Surico D, Vigone A, Bonvini D, Tinelli R, Leo L, Surico N. Narrow-band imaging in diagnosis of endometrial cancer and hyperplasia: a new option?. J Minim Invasive Gynecol. 2010;17(5):620-625. doi:10.1016/j.jmig.2009.10.014​
30. Sorosky JI. Endometrial cancer. Obstet Gynecol. 2012;120(2 Pt 1):383-397. doi:10.1097/AOG.0b013e3182605bf1​
31. Onstad MA, Schmandt RE, Lu KH. Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment. J Clin Oncol. 2016;34(35):4225-4230. doi:10.1200/JCO.2016.69.4638
32. Suri V, Arora A. Management of Endometrial Cancer: A Review. Rev Recent Clin Trials. 2015;10(4):309-316. doi:10.2174/1574887110666150923115228​
33. Wang L, Liu F. Meta-analysis of laparoscopy sentinel lymph node mapping in endometrial cancer. Arch Gynecol Obstet. 2018;298(3):505-510. doi:10.1007/s00404-018-4845-y​
34. How JA, O'Farrell P, Amajoud Z, et al. Sentinel lymph node mapping in endometrial cancer: a systematic review and meta-analysis. Minerva Ginecol. 2018;70(2):194-214. doi:10.23736/S0026-4784.17.04179-X​
35. Kogan L, Matanes E, Wissing M, et al. The added value of sentinel node mapping in endometrial cancer. Gynecol Oncol. 2020;158(1):84-91. doi:10.1016/j.ygyno.2020.04.687​
36. Stewart C, Ralyea C, Lockwood S. Ovarian Cancer: An Integrated Review. Semin Oncol Nurs. 2019;35(2):151-156. doi:10.1016/j.soncn.2019.02.001). ​
37. Kleppe M, Brans B, Van Gorp T, et al. The detection of sentinel nodes in ovarian cancer: a feasibility study. J Nucl Med. 2014;55(11):1799-1804. doi:10.2967/jnumed.114.144329 ​
38. Dell'Orto F, Laven P, Delle Marchette M, Lambrechts S, Kruitwagen R, Buda A. Feasibility of sentinel lymph node mapping of the ovary: a systematic review. Int J Gynecol Cancer. 2019;29(7):1209-1215. doi:10.1136/ijgc-2019-000606 ​
39. Kavallaris A, Zygouris D, Dafopoulos A, Kalogiannidis I, Terzakis E. Nerve sparing radical hysterectomy in early stage cervical cancer. Latest developments and review of the literature. Eur J Gynaecol Oncol. 2015;36(1):5-9.​
40. Kietpeerakool C, Aue-Aungkul A, Galaal K, Ngamjarus C, Lumbiganon P. Nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa). Cochrane Database Syst Rev. 2019;2(2):CD012828. Published 2019 Feb 12. doi:10.1002/14651858.CD012828.pub2

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