Innovation and Research

New robotic surgery helps cancer patients with fewer adverse effects

TriHealth Helps Identify a Safer Way to Stage Endometrial Cancer

A minimally-invasive procedure known as sentinel lymph node mapping accurately can determine the stage of endometrial cancer, according to new research that TriHealth contributed to that recently was published in The Lancet Oncology 

One of the onerous experiences of cancer diagnosis can be the intrusive surgery required to accurately determine the stage to which the disease has progressed. This new study shows that a much less invasive diagnosis technique is just as accurate and less traumatic for endometrial cancer patients: a robotic-assisted procedure called sentinel lymph node mapping.

Sentinel lymph nodes are the first place endometrial cancer cells are likely to spread. They are adjacent to a cancerous tumor, collecting fluid when the tumor drains. If cancer hasn’t spread to the nearest lymph nodes, it’s not likely to go beyond that.

The traditional method of detecting whether endometrial cancer has spread has been to perform a pelvic lymphadenectomy. This surgery involves removing large sections of tissue on both sides of the uterus to determine how far the cancer has spread and what treatment is best. It carries the risk of triggering lymphedema—a debilitating excess buildup of fluid in tissue—plus possible nerve injury.

Our research showed we accurately can stage endometrial cancer using a less invasive technique called sentinel lymph node mapping. We examined women whose cervix had been injected with a nontoxic dye known as indocyanine green. Indocyanine green is a tracer dye that allows us to view the lymph nodes using near-infrared fluorescence imaging. It has a high degree of diagnostic accuracy when used with a da Vinci® surgical robot.

The da Vinci robot cameras picked up the dye in each patient’s lymphatic channel, highlighting the path to the first sentinel node so we could remove it and check it for cancer. Because robotic surgery is performed with smaller incisions, it allows for a quicker recovery than traditional surgery so patients can resume normal lives sooner.

We found that sentinel lymph node mapping accurately staged endometrial cancer 97% of the time. We also saw that if our sentinel lymph node procedure showed cancer had not spread, it was accurate 99% of the time.

We observed, too, that 17% of the positive sentinel lymph nodes we discovered were outside the region usually included in a routine lymphadenectomy. In other words, the traditional procedure would have missed these nodes.

Our research, known as the FIRES (Fluorescence Imaging for Robotic Endometrial Sentinel) lymph node biopsy trial, was conducted by 18 surgeons at 10 hospitals across the country including TriHealth, and involved 385 women with endometrial cancer. It is the largest, most conclusive, prospective study about the accuracy of sentinel node mapping and endometrial cancer to date.

Endometrial cancer is the most commonly diagnosed gynecological cancer, affecting nearly 54,000 women each year. Accurate staging of endometrial cancer is important, because women who are node-positive can benefit from chemotherapy. In breast cancer and melanoma, oncologists have used sentinel lymph node biopsies for almost 25 years. Only recently have we been able to stage endometrial and uterine cancer that way.

Sentinel lymph node mapping is now the standard for women with endometrial cancer at TriHealth. With this technique, patients can have fewer lymph nodes removed, meaning less tissue damage and trauma.

As a gynecologic oncologist, I see this as significant contribution to the quality-of life-issues that many cancer patients face. Anything that reduces trauma and fear, without compromising quality, is a big step in the right direction for cancer treatment.

You can read more about what types of robotic-assisted procedures TriHealth provides at

By Kevin Schuler, MD

Kevin Schuler, MD, is a gynecologic oncologist and expert at robotic surgery at the TriHealth Cancer Institute in Cincinnati, Ohio. He is one of the authors of “A Comparison of Sentinel Lymph Node Biopsy to Lymphadenectomy for Endometrial Cancer Staging (FIRES trial): A Multicentre, Prospective, Cohort Study,” a research project led by Emma Rossi, MD, of the University of North Carolina in Chapel Hill. This study recently was published in The Lancet Oncology.

Tags Cancer , Innovation and Research , Prevention and Early Detection , Robotics