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

In view of the limitations associated with conventional axillary lymph node dissection, this article presents a detailed description of the surgical procedure for single-port endoscopic, non-liposuction axillary lymph node dissection in breast cancer. Induce general anesthesia and perform endotracheal intubation. Position the patient in a spine position with the affected side near the edge of the operating table.

Elevate the axillary region and abduct the affected arm to 90 degrees. Disinfect the surgical field with povidone iodine solution and drape the affected limb with sterile sheets. Flex the forearm to 90 degrees and secure it above the head using a curved clamp.

First, prepare one milliliter of carbon nanoparticle suspension, diluted one-to-one with normal saline. After injection, massage the area for five minutes, followed by a five minute waiting period. A longitudinal incision approximately three to five centimeter in length was made on the left lateral chest wall.

Position the patient with the forearm flexed to 90 degrees and secured above the head using a curved clamp. Incise the cribriform fascia using an electrocoagulation hook and expose the pectoralis minor muscle. Dissect outward from the surface of the pectoralis minor muscle.

Dissect the posterior axillary wall during the dissection, identify lateral thoracic vessels and the lowest intercostobrachial nerve. The division of the intercostobrachial nerve must be performed with extreme caution. The technique of utilizing tension from both pneumo dissection and a grasping forceps can be employed as a key maneuver to facilitate this dissection.

First, identify the thoracodorsal vessels. Dissect medially from the medial border of the latissimus dorsi muscle along the lateral side of the intercostobrachial nerve until reaching the thoracodorsal vessels. During the dissection, the suspension technique may be employed for nerve protection.

A fine silicone strip passed posteriorly around the nerve and secured with the sutured Hem-o-lok clip. Subsequently, a suture passer is used to percutaneously puncture the skin superior to the surface projection point of the nerve. Gentle traction is then applied to elevate the nerve away from the main operative field.

Continue the dissection superiorly until the axillary vein is visualized. Dissect along the axillary vein from lateral to medial. The dissection proceeds by separating the lateral border of the serratus anterior muscle.

The medial aspect of the thoracodorsal vessels is identified. Continuing superiority to the apex of the axilla. During dissection, pay attention to the traversing intercostobrachial nerve.

The dissected specimen is removed intact and en bloc directly through the incision. For the blue-stained lymph node visible deep in the axillary vein confluence, complete excision was achieved by leveraging the advantages of endoscopic surgery. A final inspection of the well-defined axillary cavity was performed.

Meticulous inspection confirmed complete hemostasis and the absence of any residual lymphatic tissue. Irrigate the surgical cavity with 2, 000 milliliters of warm steroid distilled water. Place a drainage tube in the axilla and connect it to a negative pressure suction device.

Close the subcutaneous tissue and skin in layers. From October 2023 to July 2024, a total of 15 patients were enrolled in this study. The mean patient age was 51.2 years.

The mean body mass index was 23.5 kilograms per square meter. The mean number of harvested axillary lymph nodes was 16.8. The mean duration of axillary lymph node dissection was 51.06 minutes.

The mean intraoperative blood loss was 8.46 milliliters. The mean postoperative drainage volume was 241 milliliters. The mean drain indwelling time was 8.13 days.

The mean hospital stay was 10 days. The mean DASH score of the affected upper limb was 11.56 at one month and 7.50 at three months postoperatively. The mean FACT-B+4 score was 106.90 at one month and 114.65 at three months postoperatively.

This study details the standardized surgical protocol for single-port endoscopic axillary lymph node dissection without liposuction in patients with breast cancer. This technique prioritizes oncological safety while enabling precise preservation of critical neurovascular structures, particularly the intercostobrachial nerve, thereby establishing a reliable strategy to minimize postoperative complications and optimize patient's quality of life.