(1) Background: Sentinel lymph node (SLN) mapping represents an accurate and feasible technique for the surgical staging of endometrial and cervical cancer. This is commonly performed by conventional laparoscopy or robotic-assisted laparoscopy, but in recent years, a new retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach has been described and developed by Jan Baekelandt. This technique provides easy visualization of lymphatic afferent vessels and pelvic lymph nodes, early SLN assessment, and a coherent mapping methodology following the lymphatic flow from caudal to cranial. However, only a few publications have reported it. Following the IDEAL (Idea Development Exploration Assessment Long-term follow-up) framework, research concerning this technique is in Stage 2a, with only small case series as evidence of its feasibility. Its standardized description appears necessary to provide the surgical homogeneity required to move further. (2) Methods: Description of a standardized approach for retroperitoneal pelvic SLN mapping by vNOTES. (3) Results: We describe a 10-step approach to successfully perform retroperitoneal vNOTES SLN mapping, including pre-, intra-, and postoperative management. (4) Conclusions: This IDEAL Stage 2a study could help other surgeons approach this new technique, and it proposes a common methodology necessary for evolving through future IDEAL Stage 2b (multi-center studies) and Stage 3 (randomized controlled trials) studies.
（1）背景：前哨淋巴结（SLN）定位是子宫内膜癌和宫颈癌手术分期中一种准确且可行的技术。该技术通常通过传统腹腔镜或机器人辅助腹腔镜进行，但近年来，Jan Baekelandt 描述并开发了一种新的经阴道自然腔道内镜手术（vNOTES）腹膜后入路。该技术能够轻松显示淋巴输入管和盆腔淋巴结，实现早期前哨淋巴结评估，并遵循从尾侧向头侧的淋巴流向提供一致的定位方法。然而，目前仅有少数文献报道此技术。根据IDEAL（构想、开发、探索、评估、长期随访）框架，关于该技术的研究处于2a阶段，仅以小型病例系列作为其可行性的证据。为了推动进一步研究，提供所需的手术同质性，对其标准化描述显得尤为必要。（2）方法：描述经vNOTES进行腹膜后盆腔前哨淋巴结定位的标准化操作路径。（3）结果：我们描述了一个包含术前、术中和术后管理的10步标准化操作路径，以成功实施腹膜后vNOTES前哨淋巴结定位。（4）结论：这项IDEAL 2a阶段的研究有助于其他外科医生掌握这项新技术，并提出了一种共同的方法论，这对于未来推进至IDEAL 2b阶段（多中心研究）和3阶段（随机对照试验）的研究至关重要。
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