The learning curve of endoscopic total mastectomy in Taiwan: A multi-center study

Abstract

IntroductionLaparoscopic techniques are commonly used in abdominal and gynecologic surgery, while breast cancer surgery has remained largely unchanged. In Asia, especially in Japan, many surgeons have started to use endoscopic surgery for breast cancer. In Taiwan, endoscopy-assisted breast surgery started in 2010. The benefits of this surgical method include smaller incisions, an axillary anatomic approach, clear vision, no oncologic compromise, and good cosmetic outcomes. This is the first report to discuss the learning curve of endoscopy-assisted breast surgery, including the difficulties experienced.Materials and methodsFrom June 2011 to December 2013, data were collected from 134 patients who received an endoscopic total mastectomy at the Taipei Medical University Hospital (TMUH) or Changhua Christian Hospital (CCH). We divided these patients into a learning group (TMUH, n = 15; CCH, n = 15) and a mature group (TMUH, n = 50; CCH, n = 54). Patient data and perioperative variables were recorded by retrospective chart review. Variables were compared using the χ2 test and Student’s t-test.ResultsThere was a significant difference in operation time (275.3 vs. 228.9 minutes, p < 0.01) between the learning and mature groups. Perioperative variables (lymph node dissection method, nipple preservation, and reconstruction method) were also analyzed, but there were no demographic differences between the groups. The complication rate was higher in the learning group, although this difference was also not statistically significant.ConclusionOur study is the first to discuss the learning curve of endoscopic total mastectomy. The operation time decreased significantly after 15 cases at each hospital. Although the operation is still more time-consuming than traditional methods, it has the benefit of smaller wounds and improved cosmetic outcomes if combined with immediate reconstruction.

Comparison of Single Incision Endoscopic Nipple-Sparing Mastectomy and Conventional Nipple-Sparing Mastectomy for Breast Cancer Based on Initial Experience

“…Despite a thorough preparation through previous studies on E-NSM, it took time to adapt to the new surgical view, endoscopic device, and position of the endoscope. The study by Hung et al [ 19 ] on the learning curve of endoscopic total mastectomies showed that the inflection point occurred after 15 to 17 cases. In our cases, the operative time for NSM decreased sharply after approximately 10 cases ( Figure 4 ).…”

A Structured, Microsurgical Training Curriculum Improves the Outcome in Lower Extremity Reconstruction Free Flap Residency Training: The Ludwigshafen Concept

“…Operation time and hospital stay are relevant parameters for the outcome of microsurgical free flaps in the literature. 17,[26][27][28] Inpatient stays and operation times were significantly reduced in cohort B (►Fig. 7).…”

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

“…However, high-level evidence of endoscopic surgery for breast cancer treatment is still lacking [38]. All patients exhibited no significant difference in postoperative survival, local recurrence or distant metastasis, and postoperative complications compared with open surgery [40][41][42][43]. And the patients receiving minimally invasive surgery is also higher than those receiving open surgery [44][45][46][47].…”