V-Notes Sentinel Lymph Node Staging for Endometrial Cancer: A Systematic Review

Background/Objectives: Sentinel lymph node (SLN) mapping has become a standard approach in the surgical staging of early-stage endometrial cancer, aiming to reduce the morbidity associated with full lymphadenectomy while preserving diagnostic accuracy. Vaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) represents a novel, minimally invasive approach for SLN mapping that may offer specific benefits in terms of access, cosmetics, and recovery, particularly in select patient populations. Methods: A comprehensive literature search was conducted in the main databases for studies evaluating the use of V-NOTES for sentinel lymph node mapping in patients with endometrial cancer. Results: Of the 12 included studies, three were observational cohort studies, while the remaining were case reports and series. The mean patient age was 59.6 years, with a majority being overweight or obese. V-NOTES was performed using both transperitoneal and retroperitoneal approaches, with indocyanine green (ICG) being the most used tracer. The overall mean SLN detection rate was 98.19%, with a bilateral detection rate of 93.7%. The average operative time was 155 min, the mean blood loss was 72.03 mL, and the average hospital stay was 2.4 days. The complication rate was low (3.9%), with no conversions to laparotomy reported. Conclusions: V-NOTES appears to be a feasible and safe alternative for SLN mapping in early-stage endometrial cancer, with high detection rates and favourable perioperative outcomes. However, due to the limited number of comparative studies and small sample sizes, further prospective research is needed to establish its efficacy relative to traditional minimally invasive techniques and to determine the optimal patient selection criteria.