Endoscopic surgery to the axilla--a substitute for conventional axillary clearance?

Nonpalpable, mammographically detected breast cancers are on the increase. The percentage of patients with histologically involved nodes is therefore decreasing. Axillary clearance aims at reducing the probability of later clinical involvement of the axilla and at establishing a sound basis for adjuvant treatment planning. Minimally invasive techniques have been applied to a growing number of surgical procedures now including exploration of the axilla. The technique used and results achieved in a series of 50 consecutive patients treated by liposuction and axilloscopy by one single surgeon, including all the patients from the very first attempt, are presented here. Patients were excluded with palpable lymph nodes or a primary tumor in the direct vicinity of the axilla that could be injured by the liposuction canula. The average number of lymph nodes removed was 13.4. Thirty-four percent of patients had involved nodes. The mean number of involved nodes in these patients was 3.1. After a median follow-up time of only 15 months no axillary recurrences or trocar site metastases have been found in the first 40 patients. Using a self-assessment questionnaire, the patients rate this technique as excellent. There was no lymphedema. The cosmetic result is certainly better than after conventional axillary clearance. Great experience of laparoscopic surgery and an excellent knowledge of the axillary anatomy are prerequisites for the practice of axilloscopic treatment of the axilla. The working space within the axilla is small and a number of structures need absolutely to be preserved. A longer follow-up period than the one so far achieved in this series or any other in the literature to date is necessary before this technique can be generally recommended.