OF BALLOON AXILLOSCOPY AND AVOIDANCE OF IATROGENIC INJURY TO THE LONGTHORACIC NERVE

Background: Laparoscopic removal of axillary lymph nodes is possible a nd affords an excellent view of all structures, allowing preservation of vessels and nerves. The technique uses pediatric trocars and a lift ing device to maintain the newly created axillary space. Objective: To prove that a newly developed technique of balloon axilloscopy can be performed using only one 10-mm and two 5-mm standard trocars and const ant carbon dioxide flow to preserve the axillary space and that preser vation of all nerves and vessels is possible with this approach. Desig n: Prospective study on 4 fresh-frozen human cadavers and 7 live porci ne models. Setting: A hospital department of minimal surgery access an d a university department of anatomy. Results: The balloon dissection consistently revealed and preserved the nerves and vessels, and exposu re and dissection of the first rib could similarly be accomplished. An alternative route to the apex of the axilla has been developed-betwee n the pectoralis minor and pectoralis major muscles-after their carefu l separation. The axillary content of surgical interest (lymph nodes) is easily separated from the other anatomical elements and is simply d issected under complete visualization and preservation of all vital ax illary structures. Conclusions: Balloon axilloscopy was easy to perfor m, provided the surgeon with constant visualization of vital anatomica l structures, and allowed easy separation and dissection of the axilla ry lymph nodes and the first rib. As a technical aid prior to a conven tional axillary dissection, or as part of a pure endoscopic procedure in the axilla, balloon axilloscopy is 100% reliable in identifying the long thoracic nerve and moving it out of the way, separating the lymp h nodes from it and from the intercostobrachial nerve and axillary vei n and artery, rendering the whole dissection process safer for both th e surgeon and the patient.