Axillary lymph node resection and thyroidectomy are two critical surgical procedures in the management of oncologic and endocrine disorders. Both surgeries require meticulous technique, precise anatomical knowledge, and careful planning to minimize complications and ensure optimal patient outcomes. Dr. R. K. Mishra, a globally renowned surgeon and pioneer in minimally invasive and robotic surgery, has emphasized these principles in his lectures, highlighting advances in surgical methods, safety strategies, and postoperative care.

Axillary Lymph Node Resection

Axillary lymph node dissection (ALND) is primarily performed for staging and treatment of breast cancer. The axilla contains several levels of lymph nodes, and their involvement helps guide adjuvant therapy, prognosis, and recurrence risk.

Indications for Axillary Lymph Node Resection

Clinically positive axillary lymph nodes on examination or imaging

Sentinel lymph node biopsy showing metastasis

Breast cancer with high-risk features requiring regional control

Recurrent disease in the axilla

Surgical Technique

Patient Positioning – The patient is placed supine with the arm abducted to 90 degrees to expose the axilla.

Incision and Exposure – A transverse or oblique incision is made along the axillary crease.

Identification of Structures – Important structures include:

Axillary vein

Long thoracic nerve (to preserve serratus anterior function)

Thoracodorsal nerve and vessels

Intercostobrachial nerves (sensory preservation if possible)

Dissection – Lymph nodes are removed from levels I, II, and sometimes III, depending on tumor involvement.

Hemostasis and Closure – Meticulous hemostasis prevents hematoma formation. Drains are often placed to prevent seroma.

Complications and Prevention

Lymphedema – Reduced by careful lymphatic preservation and physiotherapy.

Nerve Injury – Long thoracic or thoracodorsal nerve injury can cause functional deficits.

Seroma/Hematoma – Minimized with proper hemostasis and drain placement.

Dr. Mishra emphasizes surgical precision, gentle tissue handling, and anatomical knowledge as critical factors to reduce complications and improve patient quality of life.

Thyroidectomy

Thyroidectomy involves partial or total removal of the thyroid gland and is indicated for a variety of conditions including benign nodules, goiter, and thyroid malignancy. Precision is crucial because of the proximity to the recurrent laryngeal nerves, parathyroid glands, and major vessels.

Indications for Thyroidectomy

Thyroid carcinoma or suspicious nodules

Multinodular goiter causing compressive symptoms

Hyperthyroidism unresponsive to medical therapy

Cosmetic concerns in benign disease

Surgical Technique

Patient Positioning – Supine position with slight neck extension and a shoulder roll to optimize exposure.

Incision and Exposure – A low transverse incision in a natural skin crease is preferred.

Dissection Principles –

Identification and preservation of recurrent laryngeal nerves

Careful handling of parathyroid glands to prevent hypocalcemia

Meticulous ligation of superior and inferior thyroid vessels

Thyroid Removal – Depending on pathology, hemithyroidectomy, subtotal, or total thyroidectomy may be performed.

Closure – Hemostasis is confirmed, and drains are placed if needed. Skin closure is performed for optimal cosmetic outcome.

Complications and Prevention

Recurrent Laryngeal Nerve Injury – Avoided by direct visualization and careful dissection

Hypoparathyroidism – Preserved by identifying and safeguarding parathyroid glands

Bleeding and Hematoma – Immediate postoperative monitoring is critical due to airway compromise risk

Dr. Mishra highlights that minimally invasive and robotic techniques can be applied to both procedures in selected cases, enhancing precision, reducing tissue trauma, and improving recovery.

Integrating Axillary Lymph Node Resection and Thyroidectomy

In cases where patients have concurrent pathologies, such as breast cancer with thyroid disease, careful planning allows both procedures to be performed safely. Key considerations include:

Patient positioning – Sequential positioning adjustments for optimal exposure

Anesthetic management – Ensuring airway safety and monitoring during combined procedures

Tissue handling – Maintaining clear planes and minimizing trauma to prevent complications

Postoperative Care

Early mobilization and physiotherapy after axillary dissection to reduce lymphedema

Voice assessment and calcium monitoring after thyroidectomy to detect nerve injury or hypocalcemia

Pain management and wound care to enhance recovery

Patient education regarding signs of complications and long-term follow-up

Conclusion

Axillary lymph node resection and thyroidectomy are complex surgical procedures requiring expertise, careful planning, and adherence to anatomical principles. Dr. R. K. Mishra’s lectures underscore that precision, safety, and minimally invasive approaches are essential to optimize outcomes, reduce complications, and improve patient quality of life.

By integrating modern techniques, thorough anatomical knowledge, and meticulous surgical planning, surgeons can perform these procedures with maximal safety, functional preservation, and excellent oncologic outcomes, setting new standards in breast and endocrine surgery.