Thoracoscopy for internal mammary node dissection of metastatic breast cancer

Introduction: Diagnosis of metastatic breast carcinoma to the internal mammary lymph nodes is important both as a prognostic factor and for planning adjuvant chemoradiotherapy. Establishing lymph node dissection is often performed by Chamberlain's procedure, which involves intercostal incision with spreading of the pectoralis and the intercostal muscles and can be associated with complications, including bleeding from the internal mammary artery or damage to intercostal vessels and nerves. A technique is presented for video-assisted thoracoscopic internal mammary node dissection using both sentinel node evaluation and dissection. Patients and Methods: This technique was performed on 2 female patients undergoing internal mammary node evaluation after they presented with invasive ductal breast carcinoma. Results: Video-assisted dissection of the thoracoscopic internal mammary lymph nodes was successfully performed with no intraoperative complications. The postoperative course was uneventful. Conclusions: This approach can avoid damage to the internal mammary artery and intercostal spaces while providing useful information for the guidance of further therapy and achieving local control if clinically indicated.