Single-port Non-liposuction Endoscopic Axillary Lymph Node Dissection in Breast Cancer Surgery

Summary

This study describes a standardized surgical procedure for single-port endoscopic axillary lymph node dissection without liposuction in breast cancer. Indicated for patients with biopsy-confirmed nodal metastasis or positive sentinel lymph nodes, the technique emphasizes preservation of critical structures, particularly the intercostobrachial nerve, to reduce postoperative morbidity and optimize functional recovery.

Abstract

Breast cancer is the most common malignant tumor among women worldwide. For patients with a high axillary lymph node burden, axillary lymph node dissection (ALND) remains an essential component of surgical management; however, its associated complications may adversely affect long-term quality of life. With advances in endoscopic technology, ALND has progressively evolved toward minimally invasive and anatomically precise approaches. This study systematically describes the surgical steps and key technical considerations of single-port endoscopic ALND performed without liposuction.

Indications included breast cancer patients with pathologically confirmed axillary lymph node metastasis preoperatively or positive sentinel lymph nodes identified intraoperatively. A total of 15 patients were enrolled. The mean number of retrieved lymph nodes was 16.8 per patient. The mean intraoperative blood loss was 8.46 mL, and the mean total postoperative drainage volume was 241 mL. No severe intraoperative or postoperative complications were observed during the study period. This study presents a standardized surgical protocol intended to support the reproducible clinical implementation of single-port endoscopic ALND.

Introduction

Since the 2000s, the incidence of female breast cancer has increased gradually by approximately 0.6% annually. It now ranks as the second most common cancer globally and is a leading cause of cancer-related deaths among women, posing a significant challenge to women's health worldwide^1,2. The management of axillary lymph nodes plays a pivotal role in the diagnosis and treatment of breast cancer. In 1757, French scholars first proposed that axillary lymph nodes are an indispensable component of breast cancer surgery. Subsequently, William Halsted established the principle that breast cancer surgery should i....

Protocol

This study was approved by the Ethics Review Committee of The Sixth Affiliated Hospital of Sun Yat-sen University (Approval No. 2024ZSLYEC-253). Photographs and videos were used with the patient's formal written consent. The accompanying video is intended for educational purposes only. The equipment utilized in this study is listed in the Table of Materials.

1. Patient preparation

1. Patient selection
   1. Include patients with pathologically confirmed breast cancer and preoperatively or intraoperatively confirmed positive sentinel lymph nodes.
   2. Confirm that the patient has goo....

Results

From October 2023 to July 2024, a total of 15 patients were enrolled in this study. The mean patient age was 51.2 years, and the mean BMI was 23.5 kg/m². The mean duration of ALND was 51.06 min (range: 36-62 min), and the mean intraoperative blood loss was 8.46 mL (range: 3-16 mL). The mean postoperative drainage volume was 241 mL (range: 37-790 mL). The mean drain indwelling time was 8.13 days (range: 4-14 days). The mean hospital stay was 10 days (range: 5-16 days). The mean number of harvested axillary lymph nodes was.......

Discussion

This video provides a detailed demonstration of the entire procedure for single-port endoscopic-assisted axillary lymph node dissection. The key technical points of this approach include the precise identification of anatomical boundaries and standardized preservation of the intercostobrachial nerve (ICBN). The dissection plane is guided by anatomical landmarks, including the medial border of the latissimus dorsi muscle, the lateral border of the serratus anterior muscle, the axillary vein, the thoracodorsal vessels, and.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
1 mL syringe (0.45 × 16RWLB)	WEGO	20163141593
2-0 silk suture	SUYAO	201520211225
5 mm 35 cm 30° rigid endoscope	Karl Stoz	26046BA
Carbon nanoparticles suspension injection	LUMMY	H20041829
Drainage Tube	CHANGJIANG	H20041829
Electrosurgical Hook	TNKJ	20222010212
Hem-o-Lock	Weidu	WD-JZ 2S
Laparoscopic grasping forceps	YOUSHI	P20200108013
Single port	SURGAID	5012151092
suture passer	YOUSHI	P20210227004