To describe the feasibility and results of total laparoscopic radical hysterec tomy with intraoperative sentinel lymph node identification in patients with ear ly cervical cancer. Between March 2001 and October 2003, 12 patients with FIGO s tage IA2 (n = 1)or IB1 (n = 11) cancer of the cervix underwent surgical treatmen t through the laparoscopic route. All patients underwent a laparoscopic sentinel node identification with preoperative lymphoscintigraphy (technetium-99 m coll oid albumin injection around the tumor) and intraoperative lymphatic mapping wit h isosulfan blue dye and a laparoscopic gamma probe followed by systematic bilat eral pelvic lymphadenectomy and laparoscopic type II (n = 5) or type III (n = 7) hysterectomy. A mean of 2.5 sentinel nodes per patient (range 1-4) was detecte d, with a mean of 2.33 nodes per patient by gamma probe and a mean of 2 per pati ent after blue injection (combined detection rate 100%). The most frequent loca lization of the nodes was the interiliac region. Histopathologic examination of sentinel nodes including cytokeratin immunohistochemical analysis did not show m etastasis. Microscopic nodal metastases were not found. The mean number of resec ted pelvic nodes was 18.6 per patient (range 10-28). The operation was performe d entirely by laparoscopy in all patients and no case of laparotomy conversion w as recorded. The mean duration of operation was 271 min (range 235-300), with a mean blood loss of 445 mL (range 240-800), and a mean length of stay of 5.25 d ays (range 3-10). No major intraoperative complications occurred. After a media n follow-up of 20 months (range 5-34), all patients are free of disease. This study shows the feasibility of the combination of laparoscopic intraoperative se ntinel node mapping and laparoscopic radical surgery in the context of minimally invasive surgery for the management of patients with early cervical cancer.
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