Single-port three-dimensional (3D) videoscope assisted endoscopic breast surgery-Preliminary results and patient-reported satisfaction in 156 breast cancer and gynecomastia cases

Abstract

Background Minimal-accessed (robotic and endoscopic) breast cancer surgery increasingly performed due to better cosmetic results and acceptable oncological outcomes. This study aims to demonstrate the clinical safety and patient-reported cosmetic satisfaction of single-port three-dimensional (3D) videoscope assisted endoscopic breast surgery (EABS), which is our new endoscopic surgical innovation, in both malignant and benign breast conditions. Methods Patients undergone single-port 3D EABS from 1 August 2018 to 31 July 2022 in a single institution were enrolled. Clinical outcomes of this procedure were retrospectively reviewed, the patient-reported cosmetic satisfaction was evaluated by a questionnaire and reported herein. Results During the study period, 156 patients underwent 180 procedures of single port 3D EABS. 166 (92.2%) procedures were 3D endoscopic-assisted nipple-sparing mastectomy (3D E-NSM; 132 therapeutic procedures for breast cancer, 14 prophylactic contralateral mastectomies, 20 procedures for gynecomastia). 14 (7.8%) procedures of 3D endoscopic-assisted breast conserving surgery (3D E-BCS) were performed (12 3D E-BCS, 2 3D E-BCS with 3D videoscope assisted partial breast reconstruction, which was 1 case with latissimus dorsi flap and 1 case with omental flap). Mean operative time was 244 ± 110 minutes in 3D E-NSM and 260 ± 142 minutes in 3D E-BCS. Mean intra-operative blood loss was 50.2 ± 46.5 ml in 3D E-NSM and 32.8 ± 17.5ml in 3D E-BCS. Subnipple biopsy showed positive malignancy in 7 (5.4%) 3D E-NSM patients. None of the 3D E-BCS patients found margin involvement, however, those reported in 3 (2.6%) 3D E-NSM patients. Complications were found in 32 (22%) patients; 7 (4.8%) transient nipple-areolar complex (NAC) ischemia, 7 (4.8%) partial NAC necrosis, 1 (0.7%) total NAC necrosis, and 1 (0.7%) implant loss. During the mean follow up time of 27 months, there were 6 (4.7%) patients with locoregional recurrence, 7 (5.4%) distant metastasis, and 1 (0.7%) mortality. 89.3% (67/75) of patients answering the cosmetic-evaluated questionnaire reported good and excellent satisfaction. Conclusions Single-port 3D EABS is a novel surgical innovation, which is able to perform safely in either malignant or benign breast conditions and offer promising cosmetic results.