***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Nonpalpable , mammographically detected breast cancers are on the increase . The percentage of patients with histologically involved nodes is therefore decreasing . Axillary clearance aims at reducing the probability of later clinical involvement of the axilla and at establishing a sound basis for adjuvant treatment planning . Minimally invasive techniques have been applied to a growing number of surgical procedures now including exploration of the axilla . The technique used and results achieved in a series of 50 consecutive patients treated by liposuction and axilloscopy by one single surgeon , including all the patients from the very first attempt , are presented here . Patients were excluded with palpable lymph nodes or a primary tumor in the direct vicinity of the axilla that could be injured by the liposuction canula .  The average number of lymph nodes removed was 13.4 . Thirty-four percent of patients had involved nodes . The mean number of involved nodes in these patients was 3.1 . After a median follow-up time of only 15 months no axillary recurrences or trocar site metastases have been found in the first 40 patients . Using a self- assessment question naire , the patients rate this technique as excellent . There was no lymphedema . The cosmetic result is certainly better than after conventional axillary clearance . Great experience of laparoscopic surgery and an excellent knowledge of the axillary anatomy are prerequisites for the practice of axilloscopic treatment of the axilla . The working space within the axilla is small and a number of structures need absolutely to be preserved . A longer follow-up period than the one so far achieved in this series or any other in the literature to date is necessary before this technique can be generally recommended STUDY OBJECTIVE To compare endoscopic and classic axillary lymphadenectomy staging of breast cancer with respect to operation-induced changes such as seroma formation , pain , neurologic sensations , lymphedema , infection , and reduction of shoulder-arm mobility . DESIGN Prospect i ve , r and omized study ( Canadian Task Force classification I ) . SETTING University-affiliated hospital . PATIENTS Eighty consecutive women with histopathologically confirmed invasive breast cancer who had clinical ly and sonographically negative axillary lymph nodes ( < 1 cm ) . INTERVENTION Classic and endoscopic lymphadenectomies . MEASUREMENTS AND MAIN RESULTS We attempted to obtain 10 axillary lymph nodes/patient . After 1 , 3 , 5 , 7 , 9 , 42 , and 84 days , clinical and ultrasonographic examinations were conducted to evaluate operation-induced changes . Short-term results showed that , with endoscopic technique , a representative number of axillary lymph nodes was removed , with reduced axillary infiltration and seroma induction , as well as less impaired shoulder-arm mobility . During the first month , postoperative infection , lymphedema , and neurologic complaints were comparable in both groups , with more stretching pain in the classic group and predominantly paresthesia in the endoscopic group . After 3 months no differences in postoperative complications were detected . CONCLUSIONS Endoscopic axillary lymphadenectomy avoids short-term reduction of shoulder-arm mobility . Long-term studies are necessary to prove if this technique is as safe as the classic procedure with regard to local axillary recurrence . If so , endoscopy could become the method of choice for staging breast cancer in women with clinical ly negative lymph nodes Quadrantectomy with axillary-node dissection is the treatment of choice for early-stage breast cancers . The minimally invasive approach to axillary dissection has the theoretical prerequisite to be oncologically correct , while ensuring a better cosmetic result and causing less psychological distress . A prospect i ve , r and omised study was carried out to assess the feasibility and the preliminary results of video-assisted axillary-node dissection . Quadrantectomy and video-assisted axillary-node dissection ( study group = 10 patients ) was compared with st and ard quadrantectomy and axillary-node dissection  ( control group = 12 patients operated on during the same period of time ) . The early outcomes were analysed , taking into account the following parameters : patient 's age , ASA group , staging , operating time , number of nodes harvested , postoperative pain , postoperative course ( complications , lymphatic drainage , upper-limb mobility ) , hospital stay and cosmetic results at 6 months . Follow-up was 43 - 70 months in the study group and 43 - 64 months in the control group BACKGROUND Electrocautery has been postulated as a factor in the risk of seroma formation after mastectomy . METHODS Eighty consecutive mastectomies in 74 patients were r and omly assigned to dissection of the mastectomy flaps with either scalpel ( n = 38 ) or electrocautery ( n = 42 ) . Total volume of fluid output through drains and aspirated from seromas was recorded . Other factors investigated included the type of drain utilized , estimated blood loss , and complications . RESULTS Seromas developed in 16 wounds in the electrocautery group compared with 5 in the scalpel group ( 38 % and 13 % , respectively ; P = 0.01 ) . Other factors with an independent risk for seroma included use of Jackson-Pratt drains compared with Blake drains ( P = 0.006 ) , and lower estimated blood loss ( P = 0.006 ) . No differences in characteristics of patients or in other complications were noted . CONCLUSIONS Use of electrocautery to create skin flaps in mastectomy reduced blood loss but increased the rate of seroma formation OBJECTIVE To describe the technique of endoscopic exploration of the axilla . To compare this technique to open surgical treatment by comparing the following variables : operative time , peri-operative complications , duration of hospital stay , node 's histology and morphologic aspects and esthetic results . MATERIAL S St and ard instruments for traditional operative laparoscopy plus a lipo-aspirator ( 0.8 Bar ) . PATIENTS Forty patients , 20 ( group A ) undergoing open surgery and 20 ( group B ) undergoing axilloscopy . All patients with early invasive breast cancer are eligible for conservative operative treatment . METHOD R and omized study . The technique is described and preliminary results are presented . RESULTS The operative time for  axilloscopy  is approximately double that for open surgery . A comparable number of lymph nodes is collected by axilloscopy and open surgery . The nodes collected by axilloscopy are more likely to be fractured . What is the clinical consequence ? Two loco-regional relapses are observed in the endoscopic group . DISCUSSION Axillary sampling by endoscopic procedure gives the same pathologic information than surgical axillary sampling . Anatomo-pathologic aspects of nodes and possibilities of relapses were two drawbacks of this procedure . CONCLUSION Operative time is increased for axilloscopy compared with open surgery . The techniques yield comparable anatomo-pathologic results . It is still unknown whether this endoscopic technique is as effective as traditional surgery or if the frequency or severity of lymphedema is decreased by the endoscopic approach Background We prospect ively compared the sensory morbidity and  lymphedema  experienced after  sentinel node biopsy ( SLNB ) and axillary dissection ( ALND )  over a 12-month period by using a vali date d instrument . Methods Patients undergoing breast-conserving therapy completed the Breast Sensation Assessment Scale ( BSAS ) at baseline and 3 , 6 , and 12 months after surgery . Repeated- measures analysis of variance was used to compare ALND and SLNB over the 12-month period . Upper- and lower-arm circumference measurements at baseline and 12 months were used to assess lymphedema . Results SLNB was associated with substantial sensory morbidity , although significantly less than ALND , over time on all four subscales and the summary score . A statistically significant improvement in sensory morbidity occurred for both groups in the first 3 months , with no further change thereafter . For both types of axillary surgery , younger patients had significantly higher BSAS scores than older patients . There was no significant difference in arm circumference between patients with SLNB and ALND at 12 months . Conclusions Among women undergoing breast-conserving therapy  , SLNB has significant sensory morbidity , although approximately half that of ALND .  Sensory morbidity improves in the first 3 months after surgery , but patients continue to report sensory morbidity at 1 year . Longitudinal follow-up is required to further assess lymphedema Abstract Background : Sentinel node biopsy is a promising technique that allows the axillary status of breast cancer patients to be predicted with high accuracy . Reducing false negative results remains a major challenge for the improvement of this procedure . Furthermore , new techniques are required to achieve axillary clearing with less morbidity in cases of unsuccessful mapping or multicentric carcinoma . We analyzed whether axilloscopy and endoscopic sentinel node biopsy is a feasible procedure for visualization of the axillary space and resection of the sentinel node using endoscopic techniques . Methods : Following blue dye-guided lymphography and liposuction of the axillary fat , endoscopic axillary sentinel node biopsy was performed in 35 breast cancer patients . We then assessed the exposure of anatomical l and marks , the detection rate of the sentinel node , the false negative rate , and the accuracy of consecutive axillary clearing . Results : In almost every case , an excellent anatomical orientation was achieved . The detection rate for the sentinel node was 83.3 % . In one case , the sentinel node did not reflect the status of the residual axilla . A mean number of 17.1 lymph nodes was harvested at consecutive axillary clearing . Conclusions : Axilloscopy and endoscopic sentinel node biopsy , following liposuction of the axillary fat , is a feasible procedure that allows identification and minimally invasive resection of the sentinel node with high accuracy . The endoscopic approach might help to minimize the pitfalls of sentinel node biopsy by visualizing the axillary space . In future , it may become a technique that enables minimally invasive axillary clearing when complete lymphadenectomy is required BACKGROUND  Laparoscopic removal of axillary lymph nodes is possible and affords an excellent view of all structures , allowing preservation of vessels and nerves . The technique uses pediatric trocars and a lifting device to maintain the newly created axillary space . OBJECTIVE To prove that a newly developed technique of balloon axilloscopy can be performed using only one 10-mm and two 5-mm st and ard trocars and constant carbon dioxide flow to preserve the axillary space and that preservation of all nerves and vessels is possible with this approach . DESIGN Prospect i ve study on 4 fresh-frozen human cadavers and 7 live porcine models . SETTING A hospital department of minimal surgery access and a university department of anatomy . RESULTS The balloon dissection consistently revealed and preserved the nerves and vessels , and exposure and dissection of the first rib could similarly be accomplished . An alternative route to the apex of the axilla has been developed -- between the pectoralis minor and pectoralis major muscles -- after their careful separation . The axillary content of surgical interest ( lymph nodes ) is easily separated from the other anatomical elements and is simply dissected under complete visualization and preservation of all vital axillary structures . CONCLUSIONS Balloon axilloscopy was easy to perform , provided the surgeon with constant visualization of vital anatomical structures , and allowed easy separation and dissection of the axillary lymph nodes and the first rib . As a technical aid prior to a conventional axillary dissection , or as part of a pure endoscopic procedure in the axilla , balloon axilloscopy is 100 % reliable in identifying the long thoracic nerve and moving it out of the way , separating the lymph nodes from it and from the intercostobrachial nerve and axillary vein and artery , rendering the whole dissection process safer for both the surgeon and the patient Summary Background . Reports on long-term outcomes after endoscopic axillary lymph node dissection ( ALND ) of breast cancer patients are still lacking in the medical literature . The objective of this prospect i ve study was to assess the oncological and functional outcomes in breast cancer patients after endoscopic ALND .  Methods . Fifty-five breast cancer patients were prospect ively enrolled , of whom 52 were available for follow-up with a median of 71.9 months ( range 11–96 ) . The following oncological and functional endpoints were evaluated during follow-up at several time points : occurrence of local , axillary and distant metastases , seroma or infection , shoulder mobility ( range of motion ) , numbness , pain , presence of lymphoedema as well as restriction in activities of daily living . Results . In 52 patients endoscopic ALND of level I and II was successfully performed . Two port-site metastases ( 2/52 , 4 % ) occurred , one of which in a patient with negative axillary lymph nodes . The same patient suffered from the only axillary recurrence ( 1/52 , 2 % ) . Three patients ( 3/52 , 6 % ) developed lymphoedema . No other functional adverse events ( shoulder mobility , pain , numbness , hypertrophic scar ) were noticed at the end of the observation period . Conclusion . The present investigation with long-term follow-up after endoscopic ALND – the first one in the literature – reveals minor morbidity , good functional and cosmetic results . In contrary to conventional surgery , the endoscopic procedure is associated with the occurrence of port-site metastases , not seen in the open approach . Axillary recurrences do not appear more frequently when compared with results after conventional ALND . In the meantime the less invasive sentinel lymph node ( SLN ) biopsy is the established st and ard technique in evaluating the 
    Output:
    
The surgical time was longer than the open procedure .
This procedure meets the tumor control and staging requirements .
It has shown similar results to the traditional procedure in terms of patient recovery , although the available evidence is not method ologically appropriate and does not justify its oncological safety