Robotic oncologic surgery for FIGO IA endometrial cancer staging with radioguided sentinel node: first case report in Ecuador

Abstract Endometrial cancer is the most frequent gynecologic malignancy in developed countries, with increasing incidence in Latin America. Minimally invasive approaches have become the standard for early-stage disease, with robotic surgery offering enhanced ergonomics and precision. Sentinel lymph node (SLN) mapping using radioguided techniques is a validated strategy to reduce the morbidity associated with systematic lymphadenectomy while maintaining accurate staging. We report the case of a 60-year-old woman diagnosed with endometrioid adenocarcinoma, FIGO grade 1, who underwent robotic radical hysterectomy with radioguided SLN mapping. This is the first reported case in Ecuador combining robotic surgery with nuclear medicine-guided sentinel node detection. Introduction Robotic surgery and sentinel lymph node (SLN) mapping are established approaches for staging early-stage endometrial cancer. However, their combined implementation in low- and middle-income countries remains limited. This case highlights the first documented robotic staging with radioguided SLN mapping performed in Ecuador, illustrating practical considerations for institutions initiating robotic and nuclear-guided programs. Case description A 60-year-old woman with well-differentiated endometrioid adenocarcinoma underwent robotic radical hysterectomy with bilateral salpingo-oophorectomy and SLN biopsy. Preoperative SPECT/CT identified unilateral left-sided drainage, including a sentinel node at the common iliac level. Radioguided detection with Tc-99m nanocolloid and Patent Blue V enabled precise nodal localization. Surgery proceeded without complications, and the patient achieved rapid postoperative recovery with discharge on Day 3. The final pathology confirmed FIGO IA disease with negative SLNs. She remains disease-free at 12 months. Discussion This case illustrates key educational aspects for centers developing robotic staging pathways: managing unilateral SLN mapping with high-iliac drainage, integrating hybrid radioguided techniques during early learning-curve phases, and demonstrating safe, efficient postoperative recovery.