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Title
1. Introduction
2. Surgical Approach
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a. Intradermal Injection of Isosulfan Blue
b. Confirm No In-Transit Nodes with Probe
c. Marking
d. Inject Local Anesthetic
3. Incision
4. Dissection
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a. Release Edges
b. Find the Plane
c. Complete the Excision
5. Orientation of the Specimen and Hemostasis
6. Closure
7. Confirm Mapping to the Left Axilla
8. Approach to Sentinel Lymph Node Biopsy
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a. Marking
b. Inject Local Anesthetic
9. Incision
10. Dissection
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a. Dissect Down to Axillary Fascia
b. Use Probe for Orientation
c. Lift Node with Silk Stitch
d. Dissect out the Node
11. Take Count on the Node
12. Exploration for More Sentinel Lymph Nodes
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a. Dissection of Second SLN
b. Dissection of Next Node Cluster: SLN 3 and 4 with Non-Sentinel Nodes
c. Confirm No More Hot Nodes
13. Closure
14. Post-op Remarks
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Wide Local Excision of an Intermediate-Thickness Back Melanoma with a Sentinel Lymph Node Biopsy of Left Axillary Lymph Nodes
Kailan Sierra-Davidson, MD, DPhil
1
;
Ogonna N. Nnamani Silva, MD
2
;
Sonia Cohen, MD, PhD
1
1
Massachusetts General Hospital
2
Brigham and Women's Hospital
Tags:
General Surgery
Oncologic Surgery
Multidisciplinary Surgery
Main Text
Procedure Outline
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Authors
Kailan Sierra-Davidson, MD, DPhil
Ogonna N. Nnamani Silva, MD
sonia cohen
Filmed At:
Massachusetts General Hospital
Article Information
Publication Date
6/15/2023
Article ID
337
Production ID
0337
Volume
2023
Issue
337
DOI
https://doi.org/10.24296/jomi/337