Hyanyang University College of Medicine, Ansan, Gyeonggi-do, South Korea.
Adv Exp Med Biol. 2021;1187:567-590. doi: 10.1007/978-981-32-9620-6_30.
Endoscopic oncoplastic breast surgery represents a minimal invasive approach with the aim of both safe excision of cancer and preserving the breast shape. It has less noticeable scar, excellent cosmetic outcomes, high patient satisfaction rate. Recently, relative long-term follow-up results have been reported to be very safe (Soybir and Fukuma, J Breast Health 11:52-58, 2015; Fan et al., Chin Med J 122:2945-2950, 2009; Jiang, Zhonghua Wai Ke Za Zhi 45:439-441, 2007).Operative techniques for both endoscopic breast-conserving surgery and endoscopic nipple/areola/skin-sparing mastectomy have been described in detail. Two different working planes in which one of them is subcutaneous and the other one is sub-mammary planes are being used during the surgery. Surgical technique needs some instruments such as endoscopic retractor, light guided specific mammary retractor, wound protector, and energy device such as bipolar scissor, Harmonic Scalpel, LigaSure, Thunderbeat. Endoscopic breast retractors provide magnified visualization and extensive posterior dissection facility. Tunneling method and the hydro-dissection simplify the technique in the subcutaneous field (Soybir and Fukuma, J Breast Health 11:52-58, 2015; Fan et al., Chin Med J 122:2945-2950, 2009). Oncoplastic reconstruction techniques are also applied after the tumor resection by endoscopic method. The complication rate of endoscopic breast surgery is similar with the rate of open breast surgery. Quite successful local recurrence, distant metastasis, and overall survival rates have been declared. However, it looks reasonable to wait for the results with longer follow-up before having a judgement about oncologic efficiency and safety of the endoscopic breast cancer surgery (Tamaki et al., Nihon Geka Gakkai Zasshi 103(11):835-838, 2002; Leff et al., Breast Cancer Res Treat 125(3):607-625, 2011; Fukuma, Nihon Geka Gakkai Zasshi 116(5):316-319, 2015).Recently some surgeons reported about robotic nipple sparing mastectomy and immediate breast reconstruction with Gel implant procedure. Nevertheless, experience with application of a robotic surgery platform in the management of breast cancer is limited. From the preliminary experiences, R-NSM and IBR with Gel implant is a safe procedure, with good cosmetic results, and could be a promising new technique for breast cancer patients indicated for mastectomy (Lai et al., Ann Surg Oncol 26(1):42-52, 2019).
内镜肿瘤整形保乳术是一种微创方法，旨在安全切除癌症并保留乳房形状。它的疤痕不明显，美容效果极好，患者满意度高。最近，已有相对长期的随访结果报告显示其非常安全（Soybir 和 Fukuma，J Breast Health 11：52-58，2015；Fan 等人，Chin Med J 122：2945-2950，2009；Jiang，Zhonghua Wai Ke Za Zhi 45：439-441，2007）。内镜保乳术和内镜乳头/乳晕/皮肤保留乳房切除术的手术技术已详细描述。在手术过程中使用了两个不同的工作平面，其中一个是皮下平面，另一个是乳腺下平面。手术技术需要一些器械，如内镜牵开器、光导专用乳腺牵开器、伤口保护器和能量器械，如双极剪刀、Harmonic Scalpel、LigaSure、Thunderbeat。内镜乳房牵开器提供放大的可视化和广泛的后向分离设施。隧道法和水分离简化了皮下领域的技术（Soybir 和 Fukuma，J Breast Health 11：52-58，2015；Fan 等人，Chin Med J 122：2945-2950，2009）。肿瘤切除后也采用内镜方法进行肿瘤整形重建技术。内镜乳房手术的并发症发生率与开放乳房手术的发生率相似。已宣布局部复发率、远处转移率和总体生存率相当成功。然而，在对内镜乳腺癌手术的肿瘤学效率和安全性做出判断之前，等待更长时间的随访结果是合理的（Tamaki 等人，Nihon Geka Gakkai Zasshi 103（11）：835-838，2002；Leff 等人，Breast Cancer Res Treat 125（3）：607-625，2011；Fukuma，Nihon Geka Gakkai Zasshi 116（5）：316-319，2015）。最近，一些外科医生报告了机器人乳头保留乳房切除术和凝胶植入物即刻乳房重建术。然而，在乳腺癌管理中应用机器人手术平台的经验有限。从初步经验来看，R-NSM 和 Gel 植入物即刻乳房重建术是一种安全的手术，美容效果良好，可能是一种有前途的新技术，适用于需要乳房切除术的乳腺癌患者（Lai 等人，Ann Surg Oncol 26（1）：42-52，2019）。
