Surgical technique of endoscopic sentinel lymphadenectomy in the N0 neck

There is an increasing demand for sentinel lymphadenectomy, which was developed to reduce the extent of surgical interventions in cancer patients. Among surgical techniques, endoscopic technology has evolved to become an integral part of the surgical approach. However, the application of endoscopic surgery in the neck, except for thyroid surgery, has so far failed to gain widespread acceptance. The challenge of endoscopic neck surgery is to create an adequate working cavity to make surgical dissection reliable. This is especially true if levels of the neck that are distant from the skin incision are to be dissected. This article reports on the development of a minimally invasive, endoscopic lymphadenectomy via a single skin incision. Through the use of a specially designed endoscope with spreadable blades, the dissection of soft tissue in a working cavity is possible. Based on our preliminary results with this technique, the potentials and limitations of this method are discussed. However, it must be stated that the technique is still on an experimental level and has to be further improved. The technical aspects and importance of endoscopic lymphadenectomy in the neck are promising and show scientific and clinical potential. The future goal of the described technique is to perform even extended soft tissue interventions utilizing a minimally invasive endoscopic approach.