Advanced Axillary Surgery

Techniques for Dissection and Lymphatic Reconstruction

Course Description:

Risk of lymphedema is one of the major complications of any type of axillary procedure. One must master the various techniques used to not only identify and remove the sentinel lymph nodes but also perform an Axillary Lymph Node Dissection (ALND). To have the best results, one must master the various techniques, including the various approaches to nodal identification including isotope, seeds, smart clips, or magnetic particles to identify the sentinel lymph node. One should also master axillary reverse mapping to identify and protect the lymphatic drainage from the upper extremity during an axillary procedure. A small percentage of the time, the ARM lymphatics coalesce with that of the sentinel lymph node and must be transected. When this occurs during axillary reverse mapping, these lymphatics can be reapproximated or re-anastomosed to establish flow and prevent lymphedema. LYMPHA (Lymphatic Microsurgical Preventive Healing Approach) can be performed when proximal lymphatics are not available to reapproximate lymphatics to veins. This technique is particularly important when a full ALND is performed.

The course will teach these various techniques, including various approaches to performing Sentinel Lymph Node, targeted axillary dissection (TAD), ARM, LYMPHA, S-LYMHA, and ALND. US-guided Level I and II pectoral blocks for postoperative pain control will also be taught. The course will consist of didactic lectures, as well as hands-on cadaver experience.

Prior to the course, each attendee will receive access to the pre-recorded lectures. On the day of the course, attendees will have the opportunity to participate in Q&A sessions with lab faculty. At the lab, each attendee will be assigned to a station, led by a workshop faculty member, to perform all of the following procedures:

• Pec Block
• Sentinel Lymph Node Biopsy Using Various Localization Techniques
• Axillary Node Dissection
• Axillary Reverse Mapping with Preservation of Lymph Nodes
• Lymphatic Re-anastomosis

Course Objectives:

At the conclusion of this course, participants should be able to:

• Describe the lymphatic anatomy of the axilla
• Perform a Level I and II US-guided Pectoral Block
• Understand how to perform the key elements of the Axillary Reverse Mapping Procedure
• Obtain skills on LYMPHA, S-LYMPHA and re-approximation of the lymphatics
• Learn various methods for Sentinel Lymph node biopsy and targeted axillary dissection
• Learn approaches to the difficult axilla

CME Credit Information:

This live activity has been approved for AMA PRA Category 1 Credit™. Check back for credit designation updates.

Pre-recorded Didactic Agenda:

The following pre-recorded didactics will be sent to attendees prior to the course.

Onsite Agenda: