Integration of Indocyanine Green Sentinel Lymph Node Mapping and Laparoscopic Uterosacral Nerve Ablation: Advancements in Minimally Invasive Gynecologic Surgery.

Minimally invasive gynecologic surgery has witnessed significant advancements in recent years,[1-6] particularly in the areas of lymphatic mapping for endometrial cancer and pain management for chronic pelvic pain (CPP). Two emerging techniques – indocyanine green (ICG) sentinel lymph node (SLN) mapping in endometrial cancer staging and laparoscopic uterosacral nerve ablation (LUNA) for CPP – offer novel solutions that enhance patient outcomes while reducing procedural morbidity. This article synthesizes the findings from recent retrospective analyses, particularly “Application of Indocyanine Green in the Detection of Sentinel Lymph Nodes in Laparoscopic Staging Surgery for Endometrial Cancer: A Retrospective Cohort Study” and “Effectiveness, Safety, and Patient Satisfaction of LUNA in Terms of Pain Relief in Women with Chronic Pelvic Pain” to provide insight into the clinical efficacy, safety, and future directions of these techniques.[7,8] SLN mapping using ICG fluorescence has emerged as a promising technique for precise lymphatic staging in endometrial cancer. A retrospective cohort study assessing 31 patients undergoing laparoscopic SLN mapping with ICG reported an overall detection rate of 80.6%, with a sensitivity and negative predictive value of 100%. Bilateral SLN detection was achieved in 52% of cases, primarily in the external iliac region. However, challenges such as obesity and variations in injection techniques influenced mapping success. Compared to traditional pelvic lymphadenectomy, SLN mapping significantly reduces surgical morbidity while maintaining high diagnostic accuracy. This technique aligns with the National Comprehensive Cancer Network guidelines, which endorse ICG-based SLN mapping for precise staging while minimizing complications such as lymphedema and vascular injury. The high sensitivity and negative predictive value suggest that ICG SLN mapping could become a standard of care for endometrial cancer staging, particularly in the early stage disease.[7] The treatment of CPP has long been a challenging issue for gynecologists. The effectiveness of minimally invasive diagnostic and therapeutic procedures varies depending on the available equipment, surgical techniques, and the presence of adhesions or endometriosis associated with CPP. LUNA has been explored as a surgical intervention for CPP, particularly in patients without identifiable anatomical pathology.[9-13] A retrospective and observational study analyzed 13 women who underwent LUNA and reported statistically significant improvements in pain tolerance, reduction in painkiller use, and enhanced quality of life postoperatively. Patients demonstrated lower distress levels, improved ability to work, and a decrease in social isolation and sexual dysfunction. Despite these promising findings, controversy remains regarding LUNA’s long-term efficacy. While some studies suggest a significant reduction in pain perception, others report limited benefits, particularly in patients with endometriosis-associated CPP. The potential placebo effect of laparoscopic interventions further complicates outcome interpretation. Nevertheless, LUNA offers a minimally invasive alternative to more radical nerve disruption procedures such as presacral neurectomy, with fewer complications and shorter recovery times.[8] Both ICG SLN mapping and LUNA illustrate the growing role of minimally invasive techniques in gynecologic surgery. Standardization of injection techniques and increased surgeon experience may further enhance SLN detection rates, while additional prospective randomized trials are needed to definitively establish the LUNA’s role in CPP management. The integration of these techniques into routine clinical practice has the potential to refine oncologic staging and pain management, ultimately improving patient care in minimally invasive gynecology. Author contributions Writing – Original Draft Preparation; Writing – Review and Editing; Supervision, Prof. Chyi-Long Lee. The author has read and agreed to the final version of the manuscript. Data availability statement Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Editor-in-Chief