Axilloscopy is a minimally invasive surgical technique that allows direct visualization and intervention in the axillary region, particularly the axillary lymph nodes, nerves, and vessels. Over the years, it has gained importance in oncological surgery, breast surgery, and upper limb procedures due to its ability to reduce morbidity, enhance precision, and improve postoperative recovery. Dr. R. K. Mishra, a pioneer in minimally invasive surgery, has extensively lectured on axilloscopy, emphasizing its principles, techniques, and clinical applications.

Introduction to Axilloscopy

The axilla is a complex anatomical region containing:

Axillary lymph nodes – critical in breast cancer staging and treatment

Brachial plexus and its branches – responsible for upper limb function

Axillary vessels – including the axillary artery and vein

Adipose and connective tissue

Traditional open axillary dissection carries risks of nerve injury, lymphedema, and cosmetic deformity. Axilloscopy, performed through small incisions using a camera and specialized instruments, provides a minimally invasive alternative, allowing precision dissection, targeted lymph node removal, and reduced postoperative morbidity.

Indications for Axilloscopy

Dr. Mishra emphasizes that patient selection is critical. Indications include:

Breast cancer management

Sentinel lymph node biopsy or axillary lymph node dissection

Staging and therapeutic procedures with minimal tissue trauma

Treatment of axillary masses or cysts

Surgical management of hidradenitis suppurativa in the axillary region

Access for vascular or nerve procedures in complex axillary surgeries

Research and training purposes for minimally invasive axillary interventions

Advantages of Axilloscopy

Axilloscopy offers several advantages over traditional open axillary surgery:

Minimally invasive – Smaller incisions reduce scarring and improve cosmetic outcomes

Reduced postoperative pain – Limited tissue dissection preserves surrounding structures

Enhanced visualization – High-definition camera provides magnified, 3D views of nerves, vessels, and lymph nodes

Precision dissection – Reduced risk of injury to brachial plexus and axillary vessels

Shorter recovery time – Early return to normal activities and reduced hospital stay

Improved oncological outcomes – Targeted lymph node removal with minimal disruption of surrounding tissues

Preoperative Preparation

Successful axilloscopy requires meticulous preparation:

Patient Assessment

Medical history and physical examination focusing on axillary anatomy, prior surgeries, or radiation

Imaging studies such as ultrasound, CT, or MRI for lymph node mapping

Informed Consent

Discussion of risks, benefits, alternatives, and potential need to convert to open surgery

Anesthesia

General anesthesia is usually preferred; local or regional anesthesia may be used in selected cases

Positioning

The patient is positioned supine with the arm abducted to expose the axilla adequately

Care is taken to avoid brachial plexus stretch injuries

Surgical Technique
Port Placement

Small incisions (5–10 mm) are made for camera and working ports

Typical configuration includes one camera port and two or three instrument ports depending on the procedure

Creation of Working Space

CO₂ insufflation is used to expand the axillary region, creating a working cavity

Alternatively, blunt dissection and retractors may be used in cases where insufflation is not feasible

Visualization and Dissection

The camera provides magnified visualization of axillary contents

Instruments are used for careful dissection of lymph nodes, masses, or fibrous tissue

Critical structures such as the brachial plexus, axillary artery, and vein are identified and preserved

Lymph Node Removal or Other Intervention

Lymph nodes are excised individually or en bloc, depending on surgical goals

Tissue specimens are retrieved using endoscopic retrieval bags to prevent contamination and preserve tissue integrity

Hemostasis and Closure

Hemostasis is achieved using energy devices or clips

The CO₂ is released, and ports are removed

Incisions are closed with absorbable sutures or skin adhesives

Postoperative Care

Pain Management – Usually mild; analgesics as needed

Early Mobilization – Encouraged to prevent shoulder stiffness

Wound Care – Small port-site incisions generally heal quickly with minimal scarring

Follow-Up – Assessment for lymphatic complications such as lymphedema, nerve injury, or infection

Outcomes

Dr. Mishra’s experience with axilloscopy shows:

Excellent cosmetic results due to small incisions

Reduced incidence of lymphedema and nerve injury compared to open surgery

Faster recovery and early return to daily activities

High precision in lymph node excision, supporting oncological safety

Axilloscopy represents a significant advancement in minimally invasive surgery, particularly for oncological and complex axillary procedures, where precision, safety, and patient recovery are paramount.

Conclusion

Axilloscopy, as taught by Dr. R. K. Mishra, is a transformative technique in modern surgery. By combining enhanced visualization, precise dissection, and minimally invasive access, it allows safe and effective management of axillary pathology. Mastery of this technique not only improves surgical outcomes but also enhances patient satisfaction through reduced pain, faster recovery, and superior cosmetic results. As minimally invasive surgical technology advances, axilloscopy is poised to become a standard approach for axillary interventions worldwide.