Training and mentoring surgeons in lymphatic mapping

Intraoperative lymphatic mapping and selective lymphadenectomy for solid malignancies is a novel technique, having been introduced into surgical practice in the last 12 years. Dissemination of this technique among surgeons has followed a course similar to that found with the introduction of new laparoscopic techniques. A case series from a leading institution forms the core of the surgical literature for the new operation and is followed by additional case series, which offer technical refinements. Distinct from the laparoscopic techniques, however, sentinel node methodology offers a proficiency assessment through completion lymphadenectomy. Several completed clinical trials using sentinel lymph node technology have afforded a means for training and mentoring surgeons to perform the procedure. These multi-institutional studies and mentoring programs represent an initial step towards development of a more structured framework to evaluate new surgical procedures.