Features of laparoscopic ICG mapping of sentinel lymph nodes in early endometrial cancer in patients with obesity, Особливості лапароскопічного ICG картування сторожових лімфатичних вузлів при ранньому раку ендометрія за наявності ожиріння

<jats:p>Background. Endometrial cancer ranks among the most common malignant tumors of the female reproductive system. In modern gynecologic oncology, sentinel lymph node mapping is increasingly used as an alternative to systemic pelvic lympha-denectomy. Obesity is a common comorbid condition in patients with endometrial cancer, occurring in at least 60% of patients.Purpose – to evaluate sentinel lymph node detection in patients with early-stage endometrial cancer using indocyanine green guided near-infrared fluorescence laparoscopy, with particular emphasis on obese patients, to optimize the effectiveness of the procedure.Materials and Methods. A retrospective cohort study was conducted at the Department of Gynecology of the Multidisciplinary Medical Center, Odesa National Medical University, between 2018 and 2025. The study included 80 patients with low- and intermediate-risk endometrial cancer who underwent laparoscopic hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node biopsy using submucosal intracervical injection of indocyanine green. Patients were stratified into two groups according to body mass index: &lt;30 kg/m2 and ≥30 kg/m2.Results. Failure to identify sentinel lymph nodes was significantly more frequent in obese patients than in non-obese patients (35.5% vs. 10.3%; p = 0.017), resulting in a 26% reduction in the overall mapping success rate. Bilateral sentinel lymph node detection was achieved in 50.5% of obese patients compared with 60.2% of those with a BMI &lt;30 kg/m2. Operative time was significantly longer in the obese group (108.0 ± 11.6 vs. 88.5 ± 8.8 min; p &lt; 0.001). The use of partial retroperitoneal dissection increased the mapping success rate from 56.0% to 72.0%, corresponding to an absolute improvement of 16%. The optimal indocyanine green exposure interval was 15–25 minutes (p = 0.62).Conclusions. A high body mass index (≥30) is associated with a 26% decrease in the success rate of sentinel lymph node biopsy; however, it does not preclude the possibility of successful mapping. The use of additional technical techniques can increase the rate of indocyanine green uptake by 16%. One of the key factors for successful mapping is adherence to the optimal exposure time for indocyanine green (15–25 min), especially in obese patients and those who have undergone abdominal surgery.</jats:p>