Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic sentinel lymphadenectomy as a new diagnostic approach in the N0 neck

  • Head and Neck Oncology
  • Published:
European Archives of Oto-Rhino-Laryngology and Head & Neck Aims and scope Submit manuscript

Abstract

Sentinel lymphadenectomy was developed to reduce the extent of surgical interventions in cancer patients. The sentinel node (SN) concept was first established for melanoma and breast cancer; within some years, it also became increasingly popular for head and neck cancer. As soon as the required sensitivity of the method proves to be feasible in the daily clinical routine, the discussion about the best surgical approach to single or multiple SN(s) will arise. Different objectives may here compete with each other. The incision should render the best exposure of the operation site and should be expandable in case further lymph node regions have to be dissected. Finally, a good functional as well as a good cosmetic result is desirable. Endoscopic lymph node excisions were performed in patients suffering from squamous cell carcinoma of the upper aerodigestive tract located in different sites (1× uvula, 2× epiglottis, 1× glottis). In preoperatively performed ultrasonic imaging (B-mode-ultrasonography), N0 necks were assessed. In contrast to previously reported endoscopic techniques in humans, the presented method requires no insufflation of carbon dioxide or external retraction of the skin. Following laser surgical resection of the primary tumor, the SN and further lymph node(s) with accumulation of tracer substance were identified and resected endoscopically via an incision that was afterwards extended to a normal neck dissection incision. Reports of histopathologic examination of the sentinel node(s) were compared to the respective neck dissection specimens. The presented method may help to reduce the degree of invasiveness frequently attributed to sentinel lymphadenectomy once the method has been established for head and neck cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Beger HG, Schwarz A, Bergmann U (2003) Progress in gastrointestinal tract surgery: the impact of gastrointestinal endoscopy. Surg Endosc 17:342–350

    Article  CAS  PubMed  Google Scholar 

  2. Liu Y, Zhang X (2002) Analysis of complications about gynecologic endoscopic procedures in 14 hospitals of Shanghai during 1992–2001. Zhonghua Fu Chan Ke Za Zhi 37:646–649

    PubMed  Google Scholar 

  3. Einarsson JI, Young A, Tsien L, Sangi-Haghpeykar H (2002) Perceived proficiency in endoscopic techniques among senior obstetrics and gynecology residents. J Am Assoc Gynecol Laparosc 9:158–164

    CAS  PubMed  Google Scholar 

  4. Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875

    CAS  PubMed  Google Scholar 

  5. Dulguerov P, Leuchter I, Szalay-Quinodoz I, Allal AS, Marchal F, Lehmann W, Fasel JH (2001) Endoscopic neck dissection in human cadavers. Laryngoscope 111:2135–2139

    Article  CAS  PubMed  Google Scholar 

  6. Carreno OJ, Wilson WR, Nootheti PK (1999) Exploring endoscopic neck surgery in a porcine model. Laryngoscope 109:236–240

    Article  CAS  PubMed  Google Scholar 

  7. Rubino F, Deutsch H, Pamoukian V, Zhu JF, King WA, Gagner M (2000) Minimally invasive spine surgery: an animal model for endoscopic approach to the anterior cervical and upper thoracic spine. J Laparoendosc Adv Surg Tech A 10:309–313

    CAS  PubMed  Google Scholar 

  8. Bellantone R, Lombardi CP, Raffaelli M, Boscherini M, De Crea C, Traini E (2002) Video-assisted thyroidectomy. J Am Coll Surg 194:610–614

    Article  PubMed  Google Scholar 

  9. Spinelli C, Lima M, Miccoli P (2002) Video-assistive minimally invasive surgical procedures in the treatment of thyroid in children and adolescents. Pediatr Med Chir 24:217–219

    CAS  PubMed  Google Scholar 

  10. Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc. 15:1362–1364

  11. Norman J, Albrink MH (1997) Minimally invasive videoscopic parathyroidectomy: a feasibility study in dogs and humans. J Laparoendosc Adv Surg Tech A 7:301–306

    CAS  PubMed  Google Scholar 

  12. Yeung GH (1998) Endoscopic surgery of the neck: a new frontier. Surg Laparosc Endosc 8:227–232

    Article  CAS  PubMed  Google Scholar 

  13. Guerrissi JO (2002) Innovation and surgical techniques: endoscopic resection of cervical branchiogenic cysts. J Craniofac Surg 13:478–482

    Article  PubMed  Google Scholar 

  14. Rubino F, Nahouraii R, Deutsch H, King W, Inabnet WB, Gagner M (2002) Endoscopic approach for carotid artery surgery. Surg Endosc 16:789–794

    Article  CAS  PubMed  Google Scholar 

  15. Cougard P, Cheynel N, Peschaud F, Bilosi M, Goudet P (2002) Le “pneumocou” dans la vidéocervicoscopie: technique opératoire et limites anatomiques. Ann Chir 127:310–314

    Article  CAS  PubMed  Google Scholar 

  16. Werner JA, Dünne AA, Ramaswamy A, Folz BJ, Brandt D, Külkens C, Moll R, Lippert BM (2002) Number and location of radiolabeled, intraoperatively identified sentinel nodes in 48 head and neck cancer patients with clinically staged N0 and N1 neck. Eur Arch Otorhinolaryngol 259:91–96

    Article  CAS  PubMed  Google Scholar 

  17. Werner JA, Dünne AA, Ramaswamy A, Folz BJ, Lippert BM, Moll R, Behr T (2002) Sentinel node detection in N0 cancer of the pharynx and larynx. Br J Cancer 87:711–715

    Article  CAS  PubMed  Google Scholar 

  18. Werner JA, Dünne AA, Ramaswamy A, Brandt D, Külkens C, Folz BJ, Moll R, Lippert BM (2002) Das Sentinel node Konzept bei Plattenepithelkarzinomen der oberen Luft- und Speisewege – eine kritische Analyse an 100 Patienten. Laryngorhinootol 81:31–39

    Article  CAS  Google Scholar 

  19. Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, Som P, Wolf GT; American Head and Neck Society. American Academy of Otolaryngology—Head and Neck Surgery (2002) Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology and Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 128:751–758

    PubMed  Google Scholar 

  20. Monfared A, Saenz Y, Terris DJ (2002) Endoscopic resection of the submandibular gland in a porcine model. Laryngoscope 112:1089–1093

    Article  PubMed  Google Scholar 

  21. Rubino F, Pamoukian VN, Zhu JF, Deutsch H, Inabnet WB, Gagner M (2000) Endoscopic endocrine neck surgery with carbon dioxide insufflation: the effect on intracranial pressure in a large animal model. Surgery 128:1035–1042

    Article  CAS  PubMed  Google Scholar 

  22. Kitano H, Fujimura M, Kinoshita T, Kataoka H, Hirano M, Kitajima K (2002) Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation. Surg Endosc 16:88–91

    Article  CAS  PubMed  Google Scholar 

  23. Cougard P, Cheynel N, Peschaud F, Bilosi M, Goudet P (2002) Le “pneumocou” dans la vidéocervicoscopie: technique opératoire et limites anatomiques. Ann Chir 127:310–331

    Article  CAS  PubMed  Google Scholar 

  24. Naitoh T, Gagner M, Garcia-Ruiz A, Heniford BT (1998) Endoscopic endocrine surgery in the neck. An initial report of endoscopic subtotal parathyroidectomy. Surg Endosc 12:202–205

    Article  CAS  PubMed  Google Scholar 

  25. Gottlieb A, Sprung J, Zheng XM, Gagner M (1997) Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation. Anesth Analg 84:1154–1156

    CAS  PubMed  Google Scholar 

  26. Dralle H, Lorenz K, Nguyen-Thanh P (1999) Minimally invasive video-assisted para-thyroidectomy—selective approach to localized single gland adenoma. Langenbecks Arch Surg 384:556–562

    Article  CAS  PubMed  Google Scholar 

  27. Guerrissi JO (2002) Innovation and surgical techniques: endoscopic resection of cervical branchiogenic cysts. J Craniofac Surg 13:478–482

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Philipps University of Marburg, Deutschhausstr. 3, 35037, Marburg, Germany

    Jochen A. Werner, N. R. Sapundzhiev, A. Teymoortash, A. A. Dünne & B. J. Folz

  2. Department of Nuclear Medicine, Philipps University of Marburg, Marburg, Germany

    T. Behr

Authors
  1. Jochen A. Werner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. R. Sapundzhiev
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Teymoortash
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. A. Dünne
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Behr
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. J. Folz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jochen A. Werner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Werner, J.A., Sapundzhiev, N.R., Teymoortash, A. et al. Endoscopic sentinel lymphadenectomy as a new diagnostic approach in the N0 neck. Eur Arch Otorhinolaryngol 261, 463–468 (2004). https://doi.org/10.1007/s00405-003-0706-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-003-0706-8

Keywords

Search

Navigation