Minimally invasive breast surgery

Abstract

Due to the development in medical science and industrial technology, minimally invasive procedures have appeared in the surgery of benign and malignant breast diseases. In general , such interventions result in significantly reduced breast and chest wall scars, shorter hospitalization and less pain, but they require specific, expensive devices, longer surgical time compared to open surgery. Furthermore, indications or oncological safety have not been established yet. It is quite likely, that minimally invasive surgical procedures with high-tech devices - similar to other surgical subspecialties -, will gradually become popular and it may form part of routine breast surgery even. Vacuum-assisted core biopsy with a therapeutic indication is suitable for the removal of benign fibroadenomas leaving behind an almost invisible scar, while endoscopically assisted skin-sparing and nipple-sparing mastectomy, axillary staging and reconstruction with latissimus dorsi muscle flap are all feasible through the same short axillary incision. Endoscopic techniques are also suitable for the diagnostics and treatment of intracapsular complications of implant-based breast reconstructions (intracapsular fluid, implant rupture, capsular contracture) and for the biopsy of intracapsular lesions with uncertain pathology. Perception of the role of radiofrequency ablation of breast tumors requires further hands-on experience, but it is likely that it can serve as a replacement of surgical removal in a portion of primary tumors in the future due to the development in functional imaging and anticancer drugs. With the reduction of the price of ductoscopes routine examination of the ductal branch system, guided microdochectomy and targeted surgical removal of terminal ducto-lobular units or a "sick lobe" as an anatomical unit may become feasible. The paper presents the experience of the authors and provides a literature review, for the first time in Hungarian language on the subject. Orv. Hetil., 2014, 155(5), 162-169.

The Evolving Role of Vacuum Assisted Biopsy of the Breast: A Progression from Fine‐Needle Aspiration Biopsy

“…10. Close nipple proximity In the context of women contemplating a nipple-sparing mastectomy for invasive or in situ carcinoma, VAB has proven to be useful as a means of sampling the tissue immediately deep to the nipple prior to surgery to provide a preemptive assessment of the safety of proceeding in this fashion [43].…”

“…Londero et al [42] compared the malignancy underestimation rates in 300 borderline breast lesions (B3) diagnosed percutaneously using 14‐gauge core needle biopsies or 11‐gauge vacuum assisted biopsies and who subsequently went on to open surgical excisions. Of the 151 benign papillomas, 88 radial sclerosing lesions, 46 lobular neoplasia and 15 atypical ductal hyperplasia diagnosed, the malignancy underestimation rates was lower in the VAB group (12.5% vs. 12.7%), but particularly for certain subgroups of pathology such as papillomas (0% vs. 11%) and lobular neoplasia (23% vs. 40%). Close nipple proximity In the context of women contemplating a nipple‐sparing mastectomy for invasive or in situ carcinoma, VAB has proven to be useful as a means of sampling the tissue immediately deep to the nipple prior to surgery to provide a pre‐emptive assessment of the safety of proceeding in this fashion [43]. …”

“…The main complications from VAB include pain at the time the procedure and bleeding post procedurally either in the form of ongoing haemorrhaging from the skin needle entry site or a post procedural haematoma [43, 44].…”

Visual analysis of minimally invasive surgery for breast cancer: a bibliometric analysis

“…Minimally invasive breast cancer surgery (MIBCS) refers to operation on breast cancer patients with endoscopy and robotics, characterized by small incision, aesthetic and fast recovery [1][2][3][4]. Minimal invasive breast surgery conducted through a small axillary or areola incision is developing to a possible alternative to open surgery for breast cancer patients [5][6][7][8].…”