Sae-Lim Chayanee, Lai Hung-Wen, Chennavasin Papawee, Huang Hsin-I, Lin Shih-Lung, Huang Ren-Hung, Chen Shou-Tung, Chen Dar-Ren
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan.
Breast J. 2024 Dec 4;2024:6319218. doi: 10.1155/tbj/6319218. eCollection 2024.
Endoscopic-assisted breast surgery (EABS) provides better cosmetic outcomes for breast cancer patients with small incisions in an inconspicuous area. However, an extended incision and heavy assistant retraction are usually required for an adequate exposure for conventional axillary lymph node dissection (ALND). Therefore, we propose an innovative single-port three-dimensional endoscopic-assisted ALND (S-P 3D E-ALND) to facilitate better visualization, and report its preliminary outcomes herein. The surgical technique of the S-P 3D E-ALND, using either monopolar Endo Hook, LigaSure, or , is described. A total of 11 breast cancer patients who received the S-P 3D E-ALND in a single institution from January 2023 to September 2023 were enrolled. The preliminary results of the S-P 3D E-ALND, including perioperative parameters, complication, and short-term oncological outcomes, were retrospectively analyzed. Endoscopic breast and axillary procedures were conducted via a single axillary incision. The primary success rate of the S-P 3D E-ALND was 100% without a conversion to open surgery. The median operative time for the S-P 3D E-ALND was 39 (IQR = 28, 49) minutes. Average blood loss during E-ALND was 3 (IQR = 3, 5) mL. The median number of harvested LN was 10 (IQR = 8, 11) LNs. During the median follow-up time of 7 months, there was no complication, lymphedema, shoulder stiffness, or chronic arm numbness found. None of the patients reported locoregional recurrence, distant metastasis, or mortality. The S-P 3D E-ALND can serve as an alternative approach for ALND in breast cancer patients undergoing EABS, as our findings indicate it results in only minor complications.
内镜辅助乳腺手术（EABS）为乳腺癌患者提供了更好的美容效果，切口小且位于不显眼的区域。然而，传统腋窝淋巴结清扫术（ALND）为充分暴露通常需要延长切口并由助手大力牵拉。因此，我们提出一种创新的单孔三维内镜辅助ALND（S-P 3D E-ALND）以利于更好的可视化，并在此报告其初步结果。描述了使用单极内镜钩、LigaSure或其他器械的S-P 3D E-ALND的手术技术。纳入了2023年1月至2023年9月在单一机构接受S-P 3D E-ALND的11例乳腺癌患者。回顾性分析了S-P 3D E-ALND的初步结果，包括围手术期参数、并发症和短期肿瘤学结果。内镜下乳腺和腋窝手术通过单一腋窝切口进行。S-P 3D E-ALND的主要成功率为100%，无需转为开放手术。S-P 3D E-ALND的中位手术时间为39（IQR = 28，49）分钟。E-ALND期间的平均失血量为3（IQR = 3，5）mL。收获淋巴结的中位数为10（IQR = 8，11）个。在中位随访时间7个月期间，未发现并发症、淋巴水肿、肩部僵硬或慢性手臂麻木。所有患者均未报告局部区域复发、远处转移或死亡。S-P 3D E-ALND可作为接受EABS的乳腺癌患者进行ALND的替代方法，因为我们的研究结果表明其仅导致轻微并发症。
