{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:23:39Z","timestamp":1786116219723,"version":"build-2736575974"},"reference-count":46,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Axillary lymph node staging remains a cornerstone of the surgical management of breast cancer. Conventional axillary lymph node dissection (ALND) has historically been the standard procedure for evaluating nodal involvement; however, it is associated with significant morbidity, including lymphedema, sensory disturbances, and reduced shoulder mobility. Over the past few decades, minimally invasive surgery has demonstrated clear benefits in multiple surgical fields, particularly in reducing postoperative morbidity, improving recovery, and enhancing cosmetic outcomes. In breast surgery, these principles have been progressively incorporated into clinical practice. Endoscopic techniques were first introduced in the late 1990s as a minimally invasive alternative to axillary lymph node dissection. Early studies have demonstrated the technical feasibility of endoscopic axillary lymphadenectomy (EALND), reporting adequate lymph node retrieval and acceptable perioperative outcomes. Although the widespread adoption of sentinel lymph node biopsy and the progressive de-escalation of axillary surgery have limited the diffusion of this approach, the potential advantages of minimally invasive techniques appear to be applicable to axillary surgery. In recent years, minimally invasive approaches, including endoscopic and robot-assisted procedures, have been expanded in breast surgery and are now being explored for axillary management. Advances in instrumentation, optics, and imaging technologies, such as fluorescence, have improved surgical visualization and may facilitate safer and more precise dissection of axillary structures. This review summarizes the historical development, technical evolution, and current evidence regarding endoscopic axillary lymphadenectomy for breast cancer. Furthermore, we discuss the potential role of this approach in the modern era of axillary de-escalation and highlight the emerging technologies that may contribute to the future development of minimally invasive axillary surgery.<\/jats:p>","DOI":"10.3390\/cancers18152520","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:08:02Z","timestamp":1786003682000},"page":"2520","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic Axillary Lymphadenectomy in Breast Cancer: Evolution, Current Evidence, and Future Perspectives"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9558-0041","authenticated-orcid":false,"given":"Sandra","family":"L\u00f3pez Gordo","sequence":"first","affiliation":[{"name":"General and Digestive Surgery Department, Hospital Universitario de Matar\u00f3, 08304 Matar\u00f3, Spain"},{"name":"Unit of Human Anatomy and Embryology, Department of Morphological Sciences, Faculty of Medicine, Universitat Aut\u00f2noma de Barcelona, 08193 Cerdanyola del Vall\u00e8s, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humberto M.","family":"Pontillo Zile","sequence":"additional","affiliation":[{"name":"General and Digestive Surgery Department, Hospital Comarcal Sant Jaume de Calella, 08370 Calella, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4327-2754","authenticated-orcid":false,"given":"Lidia","family":"Blay Aulina","sequence":"additional","affiliation":[{"name":"General and Gastrointestinal Surgery, Hospital Germans Trias i Pujol, 08916 Badalona, Spain"},{"name":"Department of Surgery, Universitat Aut\u00f2noma de Barcelona, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3953-685X","authenticated-orcid":false,"given":"Marta","family":"Egu\u00eda Larrea","sequence":"additional","affiliation":[{"name":"Breast Unit, Department of General and Digestive Surgery, University Hospital of Salamanca, 37007 Salamanca, Spain"},{"name":"Department of Surgery, University of Salamanca, 37008 Salamanca, Spain"},{"name":"HM Sant\u00edsima Trinidad Hospital, 37007 Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Garcia-Monferrer","sequence":"additional","affiliation":[{"name":"General and Digestive Surgery Department, Hospital Universitario de Matar\u00f3, 08304 Matar\u00f3, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4617-4260","authenticated-orcid":false,"given":"Raquel","family":"Arranz Jimenez","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Prieto Nieto","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Serra-Serra","sequence":"additional","affiliation":[{"name":"Ginecology Department, Hospital Universitario de Matar\u00f3, 08304 Matar\u00f3, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"York Pineda","sequence":"additional","affiliation":[{"name":"Department of General and Digestive Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain"},{"name":"Breast Pathology Center, Fundaci\u00f3n Tejerina, 28003 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1053\/j.seminoncol.2020.09.001","article-title":"Axillary surgery in breast cancer: An updated historical perspective","volume":"47","author":"Magnoni","year":"2020","journal-title":"Semin. 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