Intraoperative support using 3D reconstructed images for sentinel lymph node biopsy in endometrial cancer surgery

Objective To evaluate the feasibility and effectiveness of intraoperative support using three-dimensional (3D) reconstructed imaging and extended reality (XR) technology for sentinel lymph node (SLN) biopsy in robot-assisted surgery for early-stage endometrial cancer (EC). Methods This retrospective study included 22 patients with early-stage EC who underwent minimally invasive robot-assisted surgery (MIRS) between April 2024 and March 2025. SLN biopsy was performed using technetium-99m (99mTc) alone or combined with indocyanine green (ICG). Preoperative simulation and intraoperative navigation were guided by 3D-reconstructed images derived from contrast-enhanced computed tomography (CT) and single-photon emission computed tomography (SPECT). XR holograms were used intraoperatively in two cases. Outcomes included SLN detection rates, operative parameters, and perioperative complications. Results At least one SLN was identified in all cases, yielding an overall detection rate of 100% (99mTc-alone: 13/13; 99mTc + ICG: 9/9). Bilateral detection rates were 76.9% and 88.9%, respectively. The 99mTc-alone method also demonstrated high performance under 3D image-guided navigation, enabling accurate localization even when ICG was not used or fluorescence visibility was limited, such as in patients with elevated BMI. No perioperative complications were recorded. XR holograms improved anatomical understanding and provided additional spatial awareness during surgery. Conclusion Intraoperative 3D imaging guidance facilitates accurate SLN identification during robot-assisted surgery for EC. The 99mTc-alone method was highly effective, and combining it with ICG further improved bilateral detection. XR technology serves as a valuable adjunct that enhances spatial orientation and surgical precision.