Zhang Qing, Xie Yanyan, Liang Faqing, Feng Yu, Du Zhenggui
Department of General Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.
Breast Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Jul 15;38(7):769-775. doi: 10.7507/1002-1892.202404034.
To review the research progress related to endoscopic surgery and robotic surgery for breast diseases, aiming to provide references for clinical practice.
The recent domestic and international literature on endoscopic surgery and robotic surgery for breast diseases was reviewed, then the challenges in their development, the innovative evolution of endoscopic surgery combined with clinical practice by our team, and its clinical applications were summarized.
Traditional endoscopic surgery, despite its advantages such as minimal invasiveness, good cosmetic outcomes, and high patient's satisfaction, has been limited in its development due to specific difficulties in establishing the operative field. Our team innovatively proposed the "reverse sequence method" and the Huaxi Hole 1 theory and methods, cleverly altering the surgical procedure sequence, adding small operative orifices to transform single-port operations into multi-port ones, effectively overcoming the challenges restricting the advancement of endoscopic surgery in the field of breast diseases, thereby enabling further proliferation of endoscopic procedures. In terms of breast endoscopic reconstruction surgery, the parachute patch technique has broadened the indications for reconstruction surgery, benefiting patients with a certain degree of breast ptosis; and the postoperative adjustment concept, through early intervention in the post-reconstruction breast shape, has further refined the reconstruction procedure. Robot-assisted surgery derived from endoscopic surgery theory has further enhanced the precision and stability of surgeries, reducing surgical risks; however, excessive time and economic costs are urgent issues that must be addressed.
Through theoretical innovations, endoscopic surgery has been applied in the excision and reconstruction of breast lesions, while robotic surgery shows promising applications in autologous breast reconstruction, especially in the latissimus dorsi reconstruction field. Nevertheless, the lack of high-level large-sample, multi-center randomized controlled clinical trials to confirm its surgical safety, oncological safety, and postoperative cosmetic outcomes is an important direction for future research.
回顾乳腺疾病的内镜手术及机器人手术相关研究进展，为临床实践提供参考。
复习近期国内外关于乳腺疾病内镜手术及机器人手术的文献，总结其发展面临的挑战、我团队结合临床实践对内镜手术的创新演进及其临床应用情况。
传统内镜手术虽具有微创、美容效果好、患者满意度高等优势，但因建立手术视野存在特定困难，其发展受限。我团队创新性提出“逆序法”及华西孔1理论与方法，巧妙改变手术操作顺序，增加小手术切口将单孔手术转变为多孔手术，有效克服了制约乳腺疾病领域内镜手术发展的挑战，从而使内镜手术得以进一步推广。在乳腺内镜重建手术方面，降落伞补片技术拓宽了重建手术适应证，使一定程度乳房下垂患者受益；术后调整理念通过对重建后乳房形态的早期干预，进一步完善了重建手术。源自内镜手术理论的机器人辅助手术进一步提高了手术的精准性和稳定性，降低了手术风险；然而手术时间过长和经济成本过高是亟待解决的问题。
通过理论创新，内镜手术已应用于乳腺病变的切除及重建，机器人手术在自体乳房重建尤其是背阔肌重建领域显示出良好应用前景。然而，缺乏高水平大样本多中心随机对照临床试验来证实其手术安全性、肿瘤学安全性及术后美容效果，是未来研究的重要方向。
