Name of the Procedure:

Biopsy or Excision of Lymph Node(s); Open, Internal Mammary Node(s)

Summary

This procedure involves removing one or more lymph nodes located near the internal mammary artery. The lymph nodes are accessed through an open surgical technique to diagnose or treat certain medical conditions, such as cancers or infections affecting the lymphatic system.

Purpose

The procedure helps diagnose, stage, or treat diseases affecting the lymph nodes, primarily cancer. By examining tissue from internal mammary lymph nodes, doctors can better understand the extent of disease spread and determine the most effective treatment plan.

Indications

• Suspicion of cancer spread (metastasis) to the internal mammary lymph nodes.
• Unexplained swelling or enlargement of these lymph nodes.
• Recurrent infections that necessitate lymph node examination. Patients typically have imaging studies indicating abnormalities in the internal mammary nodes.

Preparation

• Patients may need to fast for 8-12 hours before surgery.
• Certain medications, especially blood thinners, may need to be adjusted or paused.
• Pre-operative blood tests, imaging studies, and a physical examination are conducted to assess the patient's overall health.

Procedure Description

1. The patient is given general anesthesia for comfort and immobilization.
2. An incision is made near the sternum to access the internal mammary region.
3. The surgeon locates and carefully removes the target lymph node(s).
4. The incision is then closed with sutures, and a sterile dressing is applied. Tools used include scalpels, retractors, and surgical forceps, under sterile conditions.

Duration

The procedure usually takes about 1-2 hours, depending on the complexity and number of lymph nodes removed.

Setting

Typically performed in a hospital operating room.

Personnel

• Surgeon
• Surgical nurse
• Anesthesiologist
• Operating room technician

Risks and Complications

• Infection at the incision site
• Bleeding
• Damage to nearby structures (blood vessels, nerves)
• Adverse reactions to anesthesia
• Scarring or delayed wound healing

Benefits

• Provides a definitive diagnosis through histological examination.
• Helps in accurately staging cancers.
• Can alleviate symptoms if enlarged nodes are causing discomfort. Results from the biopsy are typically available within a week.

Recovery

• Patients will need to rest and limit strenuous activity for a few days to weeks.
• Pain management includes medications and supportive care.
• Follow-up appointments are necessary to monitor healing and discuss biopsy results.
• Instructions on wound care and signs of complications are given.

Alternatives

• Needle biopsy for less invasive sampling, though it may not provide as comprehensive a tissue sample.
• Imaging studies like PET scans, though these are not always definitive without tissue confirmation. The choice depends on the patient's overall condition and the clinical scenario.

Patient Experience

Patients will experience general anesthesia (no sensation during the procedure). Post-operatively, they may feel soreness or mild pain at the incision site, which is manageable with medication. Full recovery can take a few weeks, during which patients should monitor the incision site and follow all post-operative care instructions.