{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:47:20Z","timestamp":1782265640170,"version":"3.54.5"},"reference-count":17,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Sentinel lymph node (SLN) biopsy is a minimally invasive alternative to systematic lymphadenectomy for endometrial cancer staging. However, optimization of SLN identification during robot-assisted surgery remains an important clinical issue. This prospective exploratory study evaluated the feasibility and mapping characteristics of dual-tracer SLN mapping combining radioisotope (RI) and indocyanine green (ICG) in robot-assisted surgery for clinical stage IA endometrial cancer. Methods: Ten patients with clinical stage IA endometrioid carcinoma (grade 1 or 2) who underwent robot-assisted surgery at our institution between June 2025 and March 2026 were prospectively enrolled. Technetium-99m phytate was injected cervically the day before surgery, followed by SPECT-CT imaging. ICG was administered intraoperatively. SLNs were identified using both RI mapping and near-infrared fluorescence imaging. All patients subsequently underwent pelvic lymphadenectomy. SLN detection rates, concordance between tracers, intraoperative findings, and perioperative outcomes were evaluated. Results: The SLN detection rate with the dual-tracer method was 100% (10\/10). RI mapping alone achieved bilateral detection in 30% (3\/10), whereas ICG fluorescence imaging identified SLNs in all patients (100%). All RI-positive SLNs were also identified by ICG fluorescence imaging. In several cases, multiple fluorescent lymph nodes were observed, and gamma-probe assessment aided intraoperative SLN selection. No lymph node metastases were identified. One Clavien\u2013Dindo grade IIIa complication (pelvic hematoma requiring intervention) occurred. No adverse events related to ICG were observed. Conclusions: Dual-tracer SLN mapping using RI and ICG was feasible in robot-assisted surgery for clinical stage IA endometrial cancer. ICG fluorescence imaging provided sensitive lymphatic visualization, whereas RI mapping offered complementary information for intraoperative SLN identification in selected cases. Further prospective studies with larger cohorts are required to clarify the clinical utility of the dual-tracer approach.<\/jats:p>","DOI":"10.3390\/jcm15124705","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T10:19:53Z","timestamp":1781691593000},"page":"4705","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Initial Experience with Dual-Tracer Sentinel Lymph Node Mapping Using RI and ICG in Robot-Assisted Surgery for Early-Stage Endometrial Cancer: A Prospective Exploratory Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Masayo","family":"Okawa","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tottori University School of Medicine, Nishi-cho, Yonago-shi 683-0826, Tottori-ken, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4507-6848","authenticated-orcid":false,"given":"Hiroaki","family":"Komatsu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tottori University School of Medicine, Nishi-cho, Yonago-shi 683-0826, Tottori-ken, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Hiratsuka","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tottori University School of Medicine, Nishi-cho, Yonago-shi 683-0826, Tottori-ken, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tottori University School of Medicine, Nishi-cho, Yonago-shi 683-0826, Tottori-ken, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Hikino","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tottori University School of Medicine, Nishi-cho, Yonago-shi 683-0826, Tottori-ken, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8470-4958","authenticated-orcid":false,"given":"Yuki","family":"Iida","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tottori University School of Medicine, Nishi-cho, Yonago-shi 683-0826, Tottori-ken, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayumi","family":"Sawada","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tottori University School of Medicine, Nishi-cho, Yonago-shi 683-0826, Tottori-ken, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7707-8533","authenticated-orcid":false,"given":"Shinya","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tottori University School of Medicine, Nishi-cho, Yonago-shi 683-0826, Tottori-ken, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6922-0632","authenticated-orcid":false,"given":"Fuminori","family":"Taniguchi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tottori University School of Medicine, Nishi-cho, Yonago-shi 683-0826, Tottori-ken, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.ygyno.2017.05.027","article-title":"Sentinel lymph node mapping and staging in endometrial cancer: A Society of Gynecologic Oncology literature review with consensus recommendations","volume":"146","author":"Holloway","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1001\/jamasurg.2020.5060","article-title":"Assessment of sentinel lymph node biopsy vs lymphadenectomy for intermediate- and high-grade endometrial cancer staging","volume":"156","author":"Cusimano","year":"2021","journal-title":"JAMA Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/00000658-199409000-00015","article-title":"Lymphatic mapping and sentinel lymphadenectomy for breast cancer","volume":"220","author":"Giuliano","year":"1994","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1001\/archsurg.1992.01420040034005","article-title":"Technical details of intraoperative lymphatic mapping for early stage melanoma","volume":"127","author":"Morton","year":"1992","journal-title":"Arch. Surg."},{"key":"ref_5","first-page":"206","article-title":"Sentinel lymph node mapping with staging lymphadenectomy for patients with endometrial cancer increases the detection of metastasis","volume":"141","author":"Holloway","year":"2016","journal-title":"Gynecol. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/S1470-2045(17)30068-2","article-title":"A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): A multicentre, prospective, cohort study","volume":"18","author":"Rossi","year":"2017","journal-title":"Lancet Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/S1470-2045(11)70070-5","article-title":"Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: A prospective multicentre study (SENTI-ENDO)","volume":"12","author":"Ballester","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3749","DOI":"10.1245\/s10434-016-5236-x","article-title":"Sentinel node mapping in cervical and endometrial cancer: Indocyanine green versus conventional dyes\u2014A meta-analysis","volume":"23","author":"Ruscito","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.ygyno.2013.01.022","article-title":"Use of SPECT\/CT for improved sentinel lymph node localization in endometrial cancer","volume":"129","author":"Perissinotti","year":"2013","journal-title":"Gynecol. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Szatkowski, W., Pniewska, K., Blecharz, P., Nowak-Jastrz\u0105b, M., Ry\u015b, J., Bana\u015b, T., Pacholczak-Madej, R., Krzywonos, E., Rawoj\u0107, K., and Kisielewicz, K. (2025). 18-Hour planar scintigraphy versus SPECT\/CT for sentinel lymph node detection in early-stage endometrial cancer. Cancers, 17.","DOI":"10.20944\/preprints202508.0651.v1"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"522","DOI":"10.3332\/ecancer.2015.549","article-title":"Sentinel lymph node mapping in endometrial cancer using indocyanine green: A case report","volume":"9","author":"Rajanbabu","year":"2015","journal-title":"Ecancermedicalscience"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.ygyno.2015.03.040","article-title":"Impact of age on 30-day moImpact of age on 30-day mortality and morbidity in patients undergoing surgery for ovarian cancer","volume":"137","author":"Wiechert","year":"2016","journal-title":"Gynecol. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/jjco\/hyae170","article-title":"Comparative analysis of surgical outcomes between the hinotori surgical robot system and da Vinci Xi for simple hysterectomy with sentinel lymph node biopsy in low-risk endometrial cancer","volume":"55","author":"Togami","year":"2025","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s13304-023-01710-5","article-title":"First report of robotic-assisted total hysterectomy using the Hugo RAS system","volume":"76","author":"Komatsu","year":"2024","journal-title":"Updates Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e13344","DOI":"10.1111\/ases.13344","article-title":"New surgery technique combining robotics and laparoscopy using the Hugo RAS system","volume":"17","author":"Komatsu","year":"2024","journal-title":"Asian J. Endosc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1093\/jjco\/hyaf109","article-title":"Comparison of hysterectomy using four different robotic surgical systems: A retrospective cohort study","volume":"55","author":"Nagata","year":"2025","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1007\/s13304-025-02213-1","article-title":"First world report of ICG fluorescence angiography integrated in the HUGO\u2122 RAS system: Assessment of bowel perfusion during fully robotic right hemicolectomy for cecal cancer","volume":"77","author":"Fiorillo","year":"2025","journal-title":"Updates Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4705\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:24:10Z","timestamp":1782264250000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4705"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":17,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124705"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124705","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]}}}