Discussion

Lymphatic mapping requires a very subtle surgical technique [1]. Lymphatic vessels are very fragile and are easily damaged. Once a lymphatic vessel is acciden tally divided, the supply of blue dye stops. The remaining stretch quickly loses its color and cannot be traced any further. One needs a considerable amount of luck to find a blue node in the axilla without the lymphatic duct pointing the way. As a rule, the probe will save the day.

It is difficult to say what the best technique is to expose the lymphatic vessel. Some surgeons like to do this with a small blade, others with fine-pointed scissors. There are surgeons who use more robust instruments and spread the overlying tissue so that their assistant can divide it. The electrocautery device can also be used to dissect the lymph vessel. This device provides less ''feeling'' but has the advantage that it seals the blood vessels. It is of paramount importance to keep the operative field dry because a small amount of blood may obscure a lymphatic vessel that contains just a small amount of dye.

A laparoscope camera can be used to record the operation so that the surgeon can evaluate what went right and wrong.

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