“…When gasless endoscopic or robot-assisted nipple-sparing mastectomy is performed, the retromammary space can be easily dissected using conventional surgical instruments such as Army or Richardson retractors. The subcutaneous skin flap can be dissected with surgical scissors after injection of tumescent fluid (Hunstadt's solution, 1,000 mL Ringer's lactate + 50 mL, 1% lidocaine + 1 mL, 1:1,000 epinephrine) [ 30 ]. The lateral and medial sides of the breast can then be transected using various energy devices, including electrocautery, the LigaSure TM device (Covidien, Mansfield, USA), the Harmonic TM scalpel (Ethicon Endo-Surgery, Inc., Cincinnati, USA), or the Thunderbeat TM (Olympus, New York, USA), under an endoscopic camera.…”