Video-assisted Breast Surgery Research Articles

Preliminary Result in Endoscopic Video Assisted Breast Surgery

Background : The development of technology has grown rapidly in surgical science, especially the use of endoscopy to develop operations in producing minimal scar tissue. Endoscopic VABS is a surgical technique and began to develop since 1995. The technique has several approaches, namely through the chest wall, mammary and axilla. The descriptive study aims to report our first experience in the management of benign breast tumors with Endoscopic Video Assisted Breast Surgery.
 Methods : Ten patients with benign breast tumor have performed Endoscopic VABS in the period March 2017 to September 2017 at the Hospital in Surakarta. The largest diameter at the nodule, duration of operation, length of postoperative care, postoperative pain, cosmetic outcomes and complications were observed retrospectively.
 Result : All patients are women with median age 28 years. The largest diameter that can be taken is 3.5 cm with median 2 cm. One patient performed the conversion into a lumpectomy with conventional techniques due to difficult dissection and uncontrolled bleeding. The median duration of surgery was 60 minute with an average length of treatment for 2 days postoperatively. Average VAS Score was 4. No postoperative complications were found. But cosmetically, all patients are satisfied with the results of surgical wounds.
 Conclusion : The VABS endoscopic procedure is safe and effective procedure and has excellent cosmetic benefits because it does not show scar tissue in the breast area. This VABS Endoscopic technique has a weakness in terms of longer duration of operation compared to conventional techniques, but this can be overcome with the expertise and experience of the operator.

Video-assisted Transaxillary Nipple-sparing Mastectomy and Immediate Implant-based Breast Reconstruction: A Novel and Promising Method.

BackgroundAlthough video-assisted breast surgery is gaining popularity, endoscopic reconstruction after mastectomy is still facing lots of problems, bring about that endoscopic method has not yet become a standard procedure for breast cancer reconstruction. Here, we introduce a novel surgical technique of video-assisted transaxillary nipple-sparing mastectomy and immediate implant-based breast reconstruction and describe the detailed surgical procedure using this technique.MethodsDetailed steps of surgical procedure, the patient characteristics and the mean operative time of this new technique were described in this article. All patients were asked to score their satisfaction with their reconstructed breasts preoperatively, 1 month, 3 months, 6 months and 12 months postoperatively using the BREAST-Q.ResultsAt first, we used our “conventional method” and performed on 10 patients from April 2017 to June 2020; the operative time was 324.80 ± 66.39 minutes. After improving several procedures of the technique, the “optimized method” was performed on 14 cases from July 2020 to November 2020; the operative time decreased to 193.71 ± 28.75 minutes with shortest was 133 minutes; the optimized method was novel and easy to learn and be generalized. Most of the patients were satisfied with the reconstruction results. There was no significant difference between preoperative scores and scores at 3 months, 6 months and 12 months (p = 0.364). Since there is no wound on the breast dome, no obvious postoperative complications were observed except for one patient presented with infection.ConclusionsThis new technique has allowed surgeons to achieve excellent and reproducible outcomes in a single-stage procedure and represents an excellent technique for patients who wish to have a scarless and aesthetically pleasing appearance after mastectomy for breast cancer. This article also highlights the mean operative time (193.71 ± 28.75 minutes) that has been made possible with this new technique.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00266-021-02527-6.

Fluorescent endoscopic breast surgery to detect the sentinel node and the tumor for aesthetics of breast conserving therapy.

e12610Background: As the breast conserving surgery for early breast cancer, video-assisted breast surgery (VABS) has been reported to manipulate all performance only through the axillary minimum in...

Development of video-assisted breast cancer surgery: Initial experience with a novel method for creating working space without prior liposuction.

Endoscopic techniques are promising in breast surgery. In order to create working space, liposuction is widely used in video-assisted breast surgery (VABS). However, the use of liposuction is likely associated with side effects that may partly limit the application of VABS. Therefore, a new technique of endoscopic axillary lymphadenectomy without prior liposuction was developed by our group. A total of 106 female patients underwent VABS, with special adaptation of the video-assisted surgical procedures previously described. Differing from other endoscopic surgery techniques, our adaptations of VABS included the selection of the working instruments, trocar placement, creation of working space, order of axillary lymph node dissection and method of mastectomy. The operative time was 50–180 min (mean, 85.5 min). The intraoperative blood loss ranged from 20 to 100 ml (mean, 48 ml). The mean lymph node number harvested was 11.5 (range, 6–31). No serious intra- or postoperative complications were recorded. There was no axillary tumor relapse, trocar site tumor implantation or upper limb edema. Without prior liposuction, our new technique of VABS reduced the blood loss volume, endoscopic surgery time, total volume of drainage fluid and, most importantly, the risk of port-site metastases. This new technique appears to have great clinical potential and good prospects for future endoscopic breast surgery development.

Endoscopy-assisted surgery for the management of benign breast tumors: technique, learning curve, and patient-reported outcome from preliminary 323 procedures

BackgroundEndoscopy-assisted breast surgery (EABS), a technique that optimizes cosmetic outcome because it is performed through small wounds hidden in inconspicuous areas, could be an alternative surgical technique for benign breast tumors. In this study, we report the preliminary results of 323 EABS procedures performed at our institution for the management of benign breast tumors.MethodsThe medical records of patients who underwent EABS for benign breast lesions during the periods August 2010 to December 2015 were collected from the Changhua Christian Hospital EABS database. Data on clinicopathologic characteristics, type of surgery, hospital stay, and complications were analyzed to determine the effectiveness of the procedure for benign breast tumors. The operating time with the number of procedure performed was analyzed for learning curve evaluation. Patient satisfaction with cosmetic outcome was evaluated with a self-report questionnaire.ResultsA total of 323 EABS procedures were performed in 286 patients with benign breast lesions, including 249 (90.5%) patients with unilateral lesions. The mean age was 36 years, the mean tumor size was 2.2 cm, and the mean distance from the nipple to the tumor was 5.2 cm. Most (93.8%, 303/323) of these tumors were excised through a transareolar wound, 2.4% (8/323) through an axillary wound, and 0.3% (1/323) through the infra-mammary fold. Histopathologic analysis revealed that 63.5% (202/318) of the tumors were fibroadenoma-related lesions. The mean operative time was 81.4 min (59~89 min), which was decreased with experience increased. The overall rate of complications was 6.5%, and all were minor and wound-related. Among the 110 patients who participated in the self-report cosmetic outcome evaluation, 85.4% reported being satisfied with the cosmetic result, and almost all were satisfied with breast symmetry. Of the patients interviewed, 92.7% reported that they would choose the same procedure if they had to undergo the operation again.ConclusionsOur preliminary results show that transareolar video-assisted breast surgery is a safe and effective procedure with good cosmetic outcome and that it could be appropriate for patients with moderate to large peripherally located breast tumors.Trial registrationCCH-IRB No.15115. Registered 14 December 2015 (retrospectively registered).

311P - Long-Term Results of the Endoscopic Video-Assisted Breast Surgery Over 10 Years Evaluated for Early Breast Cancer

ABSTRACT Aim: Breast-conserving surgery (BCS) has been proven to be a standard treatment for early breast cancer. However, conventional surgery makes many long wound scars on the breast. They often make granulated ugly scars. We devised the endoscopic breast surgery to perform partial and total mastectomy without any wound on the breast. We named ithis video-assisted breast surgery (VABS). We have performed it on 350 patients since 2001. In this study, we evaluated the long-term results of the aesthetics and curability over 10 years after surgery. Methods: VABS consists of BCS, mastectomy, sentinel node (SN) biopsy, axillary node dissection, and breast reconstructions. It uses periareolar approach and/or axillary approach. Trans-axillary retromammary approach (TARM) is a single port surgery with an axillary skin incision. Each wound length is usually 2.5cm, but 1 cm for SN biopsy. This surgery is applied for early breast cancer, stage I and II. We dissected major pectoral muscle fascia to detach retromammary tissue. We cut the mammary gland with clear surgical margin. The breast reconstruction was made by filling absorbable oxydized cellulose for BCS and by silicon implant for skin-sparing mastectomy. The postoperative aesthetic results were evaluated by ABNSW. Results: BCS was performed on 300 patients and skin-sparing mastectomy on 50 patients. The operative cost is very low compared with conventional surgery. There was no significant difference in surgical invasion between VABS and conventional surgery. There was no serious complication after surgery. Surgical margin was minimally positive in 2 patients. The original shapes of the breast were preserved well. All patients expressed great satisfaction. The follow-up is 158 months at maximum. There are 3 locoregional recurrences and 14 distant metastases. 5-year survival rate is 97.5%. With regard to TARM, The skin incision only in the axilla made for better look and shape of the breast. The postoperative aesthetic results were excellent. The sensory disturbance was minimal. All patients expressed great satisfaction. Conclusions: VABS can be considered as a good surgical procedure concerning locoregional control and aesthetics. TARM is better in patients without tumor nipple extension. Disclosure: All authors have declared no conflicts of interest.

Endoscopic single port skin-sparing total mastectomy with periareolar incision: Early results.

77 Background: Early-stage breast cancer, such as DCIS, may force to complete removal of the mammary gland because of its wide spread in the breast. For such cases, skin-sparing mastectomy (SSM) should be recommended. However, the conventional oncoplastic surgery leaves some ugly scars on the breast due to large skin incisions. By applying the endoscopic video-assisted breast surgery (VABS), we can provide more aesthetic surgery with single periareolar port approach, leaving only a small and inconspicuous scar on the breast. Methods: VABS of SSM consists of periareolar skin incision, dissection of whole mammary gland, sentinel node (SN) biopsy, and axillary node (AN) dissection. After SSM, the breast reconstruction was performed by the delayed or simultaneous method. We use the implant for simultaneous reconstruction. SN biopsy was performed endoscopically with only 1 cm incision in the axilla which was marked with 3D-CT lymphography prior to surgery. For SSM, we made a skin incision of 2.5 - 3.5 cm incision at the foot-side edge of the areola, to preserve blood flow around the areola. We cut across the gland near the nipple and quickly checked the transected stump by fast frozen section. Subcutaneous detachment was applied to the entire gland. Back of the gland was peeled just above the pectoralis major muscle fascia. The liberated gland was removed through the port with a plastic bag. Results: We performed VABS on 300 patients since 2001, and SSM on 30 patients. Tumor size is 1.6 cm on average. Age is 57.2 years. 23 nipples were preserved. 17 cases were DCIS. 4 were invasive lobular carcinoma. 9 were invasive ductal carcinoma. 2 cases had SN metastasis. One case had AN metastasis. Between VABS and the conventional surgery, there was no difference in the amount of blood loss and operation time. Postoperative aesthetics was particularly good after simultaneous reconstruction. They had less sensory disturbance and high satisfaction. After 38 months, there have been no distant metastases, no postoperative deaths, and one local recurrence). Conclusions: VABS SSM with periareolar skin incision approach makes better aesthetic results.

Comparison of long-term results of endoscopic video-assisted breast surgery (VABS) between trans-axillary retro-mammary appcoach (TARM) and periareolar approach.

167 Background: The breast conserving surgery (BCS) and the sentinel node (SN) biopsy became to be recognized as the standard treatment for early breast cancers. We have reported about cosmetic effectiveness and lower infestation of the video-assisted breast surgery (VABS) for the breast diseases. We devised the trans-axillary retro-mammary (TRAM) approach of VABS. It needs only one skin incision in the axilla and can treat any tumor of the breast without making any injuries on the breast skin. We evaluated the aesthetic results and the curability of this surgical method. Methods: We have performed VABS on 300 patients since December 2001. The newly devised TARM was performed on 120 patients of early breast cancer, stage I and II. After endoscopic SN biopsy, we elongated the axillary skin incision to 2.5 cm. We dissected major pectoral muscle fascia to detach retromammary tissue behind the tumor. We cut the mammary gland with clear surgical margin, and removed it through the axillary port. The breast reconstruction was made by filling absorbable oxydized cellulose. The postoperative aesthetic results were evaluated by ABNSW. Results: BCS was performed on 286 patients (26 after preoperative chemotherapy) and skin-sparing mastectomy on 14. There was no serious complication after surgery. Surgical margin was minimally positive in 2. The original shapes of the breast were preserved well. The follow-up is 126 months at maximum and 74 months on average. There is 3 locoregional recurrences and 14 distant metastases. 5-year survival rate is 97.3%. With regard to TARM, The skin incision only in the axilla made better looks and shapes of the breast. It could be applied for tumors in any area of the breast without tumor nipple extension. The reconstruction with oxidized cellulose needs no excessive detachment of the skin beyond the surgical margin. The postoperative esthetic results were excellent and better. The sensory disturbance was minimal. All patients expressed great satisfaction. Conclusions: VABS can be considered as a good surgical procedure concerning locoregional control and esthetics. TARM is better on the patients without tumor nipple extension.

170. The improved Trans-axillary Retromammary (TARM) approached video-assisted breast surgery is easier and feasible for the clinical use

Background: The breast conserving surgery and the sentinel node (SN) biopsy became to be recognized as the standard treatment for early breast cancers. We have reported about cosmetic effectiveness and lower infestation of the video-assisted breast surgery (VABS) for the breast diseases. We devised the trans-axillary retro-mammary (TRAM) approach of VABS. It needs only one skin incision in the axilla and can treat any tumor even in the medial or lower side of the breast without making any injuries on the breast skin.

Comparison of long-term results of endoscopic video-assisted breast surgery (VABS) between transaxillary retromammary approach (TARM) and periareolar approach.

1112 Background: The breast conserving surgery (BCS) and the sentinel node (SN) biopsy became to be recognized as the standard treatment for early breast cancers. We have reported about cosmetic effectiveness and lower infestation of the video-assisted breast surgery (VABS) for the breast diseases. We devised the trans-axillary retro-mammary (TRAM) approach of VABS. It needs only one skin incision in the axilla and can treat any tumor of the breast without making any injuries on the breast skin. We evaluated the aesthetic results and the curability of this surgical method. Methods: We have performed VABS on 300 patients since December, 2001. The newly devised TARM was performed on 120 patients of early breast cancer, stage I and II. After endoscopic SN biopsy, we elongated the axillary skin incision to 2.5 cm. We dissected major pectoral muscle fascia to detach retromammary tissue behind the tumor. We cut the mammary gland with clear surgical margin, and removed it through the axillary port. The breast reconstruction was made by filling absorbable oxydized cellulose. The postoperative aesthetic results were evaluated by ABNSW. Results: BCS was performed on 286 patients (26 after preoperative chemotherapy) and skin-sparing mastectomy on 14. There was no serious complication after surgery. Surgical margin was minimally positive in 2. The original shapes of the breast were preserved well. The follow-up is 126 months at maximum and 74 months on average. There is 3 locoregional recurrences and 14 distant metastases. 5-year survival rate is 97.3%. With regard to TARM, The skin incision only in the axilla made better looks and shapes of the breast. It could be applied for tumors in any area of the breast without tumor nipple extension. The reconstruction with oxidized cellulose needs no excessive detachment of the skin beyond the surgical margin. The postoperative esthetic results were excellent and better. The sensory disturbance was minimal. All patients expressed great satisfaction. Conclusions: VABS can be considered as a good surgical procedure concerning locoregional control and esthetics. TARM is better on the patients without tumor nipple extension.

Abstract P4-10-08: Trans-Axillary Retro-Mammary Approach of Video-Assisted Breast Surgery Uses Single Port in the Axilla and Treats Any Tumors Even in the Medial or Lower Side of the Breast

Abstract Background: The breast conserving surgery and the sentinel node (SN) biopsy became to be recognized as the standard treatment for early breast cancers. We have reported about cosmetic effectiveness and lower infestation of the video-assisted breast surgery (VABS) for the breast diseases. When the tumor exists in the medial or lower side of the breast, we usually use the periareolar incision. However, it often makes deformation or malposition of nipple and areola, and sensory disturbance around them. We devised the trans-axillary retro-mammary (TRAM) approach of VABS. It needs only one skin incision in the axilla and can treat any tumor even in the medial or lower side of the breast without making any injuries on the breast skin. And it can preserve skin touch sensation. Methods: We have performed video-assisted breast surgery (VABS) on 300 patients since December, 2001. The newly devised TARM was performed on 120 patients of early breast cancer, stage I and II. After endoscopic sentinel lymph node biopsy, we elongated the axillary skin incision to 2.5 cm. We marked the surgical margin 2 cm apart from the tumor edge by injecting blue dye into subcutane and retromamma. We dissected major pectoral muscle fascia to detach retromammary tissue under the tumor. The working space was made by lifting traction sutures through the gland. We cut the proximal side of the gland vertically at dye marking points, and dissect skin flap over the tumor by tunnel method. Then we cut each sides of the gland vertically and removed it through the axillary port by using Endocatch, tumor collection bag. The breast reconstruction was done by filling absorbable fiber cotton, oxidized cellulose. Results: The tumor size was 2.2 cm on average. The patient age was 50.2 years. We had to take much care not harming the skin over the tumor. TRAM was performed without major complications. The working space was made only enough for the resection of the gland without excessive detachment of the surrounding subcutaneous tissue. The fifty tumors in the medial side of the breast were resected in success by TARM. Traction sutures made it easier to cut the mammary gland vertically. We did not experience any skin damages like burn. All surgical margins were negative. The operation time was needed 45 minutes longer than the conventional VABS operation, but the blood loss and other surgical stress factors were not significantly different. The postoperative esthetic results were good. The oxidized cellulose cotton was good for preserving the breast form, because it collects fluid to make temporal seroma and became a solid fibrous mass on six months after surgery. The average follow up period is 60 months. There was only two local recurrences. The sensory disturbance was minimal. All patients were satisfied with this operation. Conclusions: This newly devised TARM approach of VABS needs no injury on the whole breast, and can become to be a standard method of the breast conserving surgery for early breast cancer wherever it may exist in the breast. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-10-08.

Endoscopic breast surgery: where are we now and what might the future hold for video-assisted breast surgery?

Endoscopic surgery has been extensively used for many surgical conditions and has gained acceptance as an alternative and less invasive approach to open surgery. However, minimal access endoscopic techniques have yet to be translated into mainstream clinical practice in breast surgery. More recently, technical innovations have made it feasible to conduct endoscopic breast cancer resection, with or without breast reconstruction, through wounds inconspicuously hidden in the axilla and periareolar region. Several clinical trials have now been conducted to demonstrate technical feasibility, assess safety and provide follow up data regarding oncological success of endoscopic breast surgery. This primary aim was to critically evaluate the literature in order to determine the oncological and cosmetic efficacy of endoscopic breast surgery. A systematic review was conducted using Medline, Ovid and Embase to identify original data from studies of endoscopic breast surgery. Initial results have demonstrated that endoscopic breast surgery is safe and technically feasible. Early data suggests that it is possible to achieve disease control with high rates of overall survival and low rates of local relapse recurrence and/or distant metastases. However, the absence of level I randomised clinical evidence currently precludes a recommendation that endoscopic breast cancer surgery is capable of achieving equivalent oncological outcomes to open surgery.

SPECT-fused 3D-CT mammary lymphography for endoscopic sentinel node biopsy.

e11041 Background: The endoscopic surgery for the breast diseases has been proven safe and aesthetic, and named as video- assisted breast surgery (VABS). We also applied it for the sentinel node (SN) biopsy. It needs only 1 cm-long skin incision and a narrow tunnel to SN. However, it sometimes has difficulty in detecting the dye-stained node. The radioisotope (RI) may not be uptaken by true SN. We firstly succeeded to fuse the single photon emission computed tomography (SPECT) with 3D-CT mammary lymphography (LG). It can show the detailed position of all SN with or without RI uptake. Methods: 3D-CT LG was performed to mark SN on the skin. Above the tumor and near the areola, 2 mL of Iopamidol 300 was injected subcutaneously. Images of CT scan were taken at 1 and 3 minutes after injection to produce a 3D image of lymph ducts and nodes. For the lymphoscintigraphy, 99mTc phytate 74mBq was injected, and SPECT was taken after 2 hours. We fused it with 3D-CT LG. SN biopsy was performed by dye and RI method The skin incision was made 1 cm long in the axilla on the marked position. The endoscopic view was made through the optical trocar Visiport and showed stained lymph ducts and SNs, which can be navigated by the RI detector probe. Results: We have performed VABS on 260 patients, SN biopsy by the dye-staining method on 50 patients, with 3D-CT LG on 160 patients, and SPECT fused 3D-CT LG on 20 patients. All RI positive SNs coincided with 3D-CT LG detected SNs. We could detect their position on the axillary lymphatic mapping by the RI detector probe during surgery. The average sampled number of SN was 2.3. The dye-negative SN and RI-negative SN could be removed endoscopically. The SN metastases were 45 (28%). The other non-SN of axillary nodes could be observed. There was no false negative study. The wound scars were inconspicuous and aesthetic. Conclusions: SPECT-fused 3D-CT LG facilitates the endoscopic SN biopsy, which is aesthetic and less invasive. No significant financial relationships to disclose.

Video-Assisted Breast Surgery and 3-Dimensional Computed Tomographic Mammary Lymphography <1> Aesthetic Results and Curability of Video-assisted Breast Surgery

Background: I have studied endoscopic surgery for breast diseases and have studied 3-dimensional computed tomographic lymphography for sentinel node biopsy. In this chapter, I introduced my works of the endoscopic breast surgery. I devised a new endoscopic operation for breast diseases: video-assisted breast surgery. The goal of endoscopic breast surgery is to obtain better cosmetic outcomes. Methods: A 2.5-cm axillary or periareolar skin incision was made. Under video assistance, the mammary gland was partially or totally resected with a gasless method. A transaxillary retromammary route approach was used even for tumors of the medial aspect of the breast. For malignant tumors, sentinel node biopsy was performed, and axillary nodes were dissected. Breast reconstruction was performed simultaneously. Cosmetic results: Cosmetic results were assessed with a standard 4-step method and the method described in the Japanese guidelines for breast-conserving therapy. More-objective quantitative methods are breast retraction assessment, the method reported by the research group of Sawai, and ABNSW, a 5-item, 4-step method that evaluates asymmetry (A) , breast shape (B) , nipple deformation (N) , skin condition (S) , and wound scar (W) . The cosmetic results in endoscopic breast surgery showed that almost 90% of patients received a total score greater than 11 points, which indicates that this video-assisted breast surgery achieves better cosmetic results. The reconstruction methods in breast-conserving therapy are mammary gland translocation, the lateral tissue flap filling method, and absorbable thread mesh filling. The filling methods are superior to the translocation at the point of less deformation of the breast shape. Reconstruction with filling methods will allow wider excision of the mammary gland while achieving better cosmetic results. Results: Video-assisted breast surgery is less invasive, produces no scars on the breast skin, and achieves better aesthetic outcomes for patients with breast cancer. It also improves quality of life. The long-term results of this surgery in regards to morbidity have proven good after a maximum follow-up period of 8 years. Conclusions: Video-assisted breast surgery achieves good locoregional control and provides aesthetic advantages. It can be used to treat multiple breast diseases and advanced disease after preoperative systemic treatment.

Retromammary Approach for Endoscopic Resection of Benign Breast Lesions

One of the merits of endoscopic surgery is that it can be performed through small remote incisions made in inconspicuous areas. To improve cosmetic outcomes of surgical treatment of benign breast lesions, we performed endoscopic surgery through minimally sized axillary incisions with the goal of achieving scar-free breasts. From August 2007 to August 2008, 18 patients with 20 benign breast lesions underwent endoscopic breast excision in our institution. Endoscopic resection of benign breast lesions was performed via the retromammary route with video assistance. Cosmetic results were evaluated using the five-item, four-step ABNSW scoring system, assessing breast asymmetry, breast shape, nipple shape, skin condition, and wound scars. The median age of the patients was 27 years (IQR 23.0, 29.0). Median resected lesion size was 3.3 cm (IQR 2.9, 3.9). Median operative time was 85.0 min (IQR 70.0, 100.0). A marginally significant difference in operative times was noted between fibroadenoma and/or juvenile fibroadenoma cases and mastopathy or benign phyllodes cases (80.0 vs. 100.0; p < 0.06). Median total ABNSW score was 14 points. Postoperatively, 5 patients had mild local subcutaneous emphysema, and one had transient brachial palsy. No breast ecchymosis or deformity was noted. No major complications developed in any patient, and 89% of patients had good or excellent results. Video-assisted endoscopic breast surgery has changed routine breast surgery, manifesting cosmetic effects that cannot be achieved by previous routine surgical techniques. Patients with multiple or large benign tumors who desire excellent cosmetic results are good candidates for this approach.

Retromammary Approach for Video-assisted Endoscopic Resection of Benign Breast Tumors: Report of Two Cases

Traditional breast surgery always leaves a scar not only on the breast but also on the mind of the patient. Endoscopic breast surgery, which was initially in cosmetic surgery, has made great progress in the past 10 years, and now is applied to resection of breast lesions, benign or malignant, in Western countries as well as in Asian countries, e.g., Japan, China mainland, Korea, and Hong Kong. In these previous reports, excellent cosmetic outcomes were achieved. Nevertheless, to the best of our knowledge, there are no such articles published in Taiwan. We hereby describe successful extirpation of multiple or large benign breast tumors in two young female patients, using endoscopic devices through a retromammary space approach. The patients were greatly satisfied with this method because of the final esult of scar-free breasts. Video-assisted endoscopic breast surgery has made a reat contribution to breast operations, and produces cosmetic effects that cannot be chieved by traditional surgery. Patients with multiple or large benign tumors, specially young females, are good candidates for this surgery.

Video-assisted breast surgery can sample the second and third sentinel nodes to omit axillary node dissection for sentinel-node-positive patients

The preservation of the axillary node (AN) has become standard therapy for early breast cancer patients with a metastasis-positive sentinel node (SN). However, about half of the patients with metastasis in the SN have no metastasis in the other AN. Late-phase three-dimensional computed tomographic lymphography (3D-CT LG) of the breast can show the axillary lymphatic architecture from the SN into the venous angle. These nodes are classified into five groups. For the sake of aesthetics, video-assisted breast surgery (VABS) was used to sample the second and third nodes shown by 3D-CT LG. For marking the SN on the skin, 3D-CT LG was performed the day before the surgery. Iopamiron 300 (2 ml) was injected subcutaneously. A 16-channel multidetector-row helical CT image was reconstructed to produce a 3D image of the lymph ducts and nodes. A biopsy of the SN was performed by the dye-staining method using Visiport-aided endoscopy for VABS. Stained nodes were located by following the dye in the lymph ducts on a video monitor. For SN-metastasis-positive patients, standard AN dissection was performed under video assistance. Since July 2002, the authors have performed SN biopsy for 186 patients as well as 3D-CT LG and VABS SN biopsy for 146 patients. Five chained-node groups were shown. Even in the multiple SN case, the lymph ducts were converging into the second node. The second and third nodes beyond the SN were detected and sampled in 82 patients (56.2%) by VABS assisted with 3D-CT LG. Sentinel node metastasis (n = 40) involved SN metastasis alone in 21 cases (52.5%) and SN, second-node, and third-node metastasis in eight cases. A reviewed lymphoid path by 3D-CT LG confirmed that metastasis occurred in order of lymph flow. The use of 3D-CT LG-guided VABS SN biopsy of the second and third nodes will predict SN metastasis alone and help to obviate the need for dissection of more nodes.

Trans-axillary retro-mammary gland route approach of videoassisted breast surgery can perform breast conserving surgery for cancers even in inner side of the breast

The endoscopic surgery for inner-side cancer of the breast is usually performed by periareolar approach, but it often makes deformation or malposition of nipple and areola. The trans-axillary approach is favorable without making any injuries on breast skin. Furthermore, we devised a new approach of retro-mammary route without subcutaneous exfoliation, from axillary skin incision, to preserve skin touch sensation. We have performed video-assisted breast surgery (VABS) on 200 patients since December 2001. The newly devised trans-axillary retromammary-route approach (TARM) was performed on 12 patients of early breast cancer. After endoscopic sentinel lymph node biopsy, we lengthened the axillary skin incision to 2.5 cm, and dissected retromammary tissue from superficial pectoral fascia onto major pectoral muscle below the tumor. The working space was made by lifting traction sutures through the gland. We cut the gland vertically at free margin 2 cm apart from the tumor edge, and dissect skin flap over the tumor. The breast reconstruction was done by filling absorbable fiber cotton. Traction sutures made it easier to cut the mammary gland vertically. We did not experience any skin damages like burn. All surgical margins were negative. The operation time was needed longer but the blood loss was not different. The postoperative esthetic results were good. The sensory disturbance was minimal. All patients were satisfied with this operation. This newly devised TARM approach need no injury on whole breast, and can become a single standard method for breast conserving surgery wherever the cancer situated.

Transaxillary retromammary route approach of video-assisted breast surgery enables the inner-side breast cancer to be resected for breast conserving surgery

Background Endoscopic surgery for inner-side breast cancer usually is performed by periareolar approach, but leaves deformation or malposition, and sensory disturbance. We devised an approach of retromammary route without subcutaneous removal, from an axillary skin incision, to treat distant cancers and also to preserve sensation to skin touch. Methods We have performed video-assisted breast surgery on 230 patients. The transaxillary retromammary-route approach was performed on 20 patients with early breast cancer. From a 2.5-cm axillary incision, we dissected the major pectoral muscle fascia to detach retromammary tissue. We cut the proximal side of the gland vertically, and dissected the skin flap over the tumor by the tunnel method. Then we cut each side of the gland vertically and removed it through the axillary port. Results All surgical margins were negative. The surgical time was 45 minutes longer than the conventional video-assisted breast surgery. The postoperative esthetic results were good. Conclusions The transaxillary retromammary-route approach leaves no injury on whole breast, and can become a single standard method for breast-conserving surgery wherever a cancer is situated.

Trans-axillary retro-mammary (TARM) approach of video-assisted breast surgery (VABS) applied for breast conserving surgery of cancers even on inner-side of the breast

To evaluate the efficacy and safety for use of dual radioisotopes for localization of occult (impalpable) breast lesions and sentinel node biopsy as a combined technique (SNOLL) using a lower dose than previous studies.One hundred and twenty-seven SNOLL procedures were performed. The impalpable breast lesions were localized with an intra-lesion injection of 0.2 ml of 99mTc MAA (1 MBq) with a particle size of 10–90 μm (radio-guided occult lesion localization, or ROLL) 1 to 4 h before surgery. Sentinel node localization was performed using 0.2 mls of 99Tc nanocolloid (20 MBq) particle size no greater than 80 nm injected subdermally in the periareolar region within the index quadrant, the night before or the morning of surgery.Lesion localization was consistently achieved with a lower dose than that described in other studies without the need to use scintigraphy or additional imaging with radioopaque contrast medium. One hundred percent lesion localization with a negative clearance margin of 94.8% and 100% sentinel node localization was achieved. The use of dual radioisotopes with the lower dose used for ROLL did not compromise the localization of the impalpable lesion or the sentinel nodes.The combined use of radioisotopes for lesion and sentinel node removal is feasible and reliable with the lower radioisotope dose suggested compared with previously published studies. This method should be recommended as a standard procedure for SNOLL.