The conventional oncoplatsic breast surgery makes many large wound on the breast, wide area of skin detachment, gland mobilization, and autografting, which result in large granulated ugly scars, uncomfortable numbness of the breast. We devised endoscopic video-assisted breast surgery (VABS) to perform partial and total mastectomy without any wound on the breast and with minimal management of breast tissue. To obtain the minimum clear surgical margins and to improve the aesthetics of the breast after surgery, we tried to navigate VABS by the virtual endoscopic mode (VEM) of 3D-CT. We evaluated the aesthetic results and QOL of VABS.
In 3D-CT LG, 2 ml of Iopamidol 300 was injected subcutaneously above the tumor and the periareola. CT scan was taken 1 minute after injection to produce a 3D image of lymph ducts and nodes. VABS consists of breast conserving surgery, mastectomy, SN biopsy, axillary node dissection, and breast reconstructions. Trans-axillary retromammary approach (TARM) is a single port surgery with an axillary skin incision. The each wound length is usually 2.5 cm, but 1cm for SN biopsy. We cut the mammary gland with clear surgical margin from behind the mammary gland. VEM of 3D-CT images are overlaid on the endoscopic view to navigate precise SN biopsy and clear surgical margins. The aesthetic results and QOLs were evaluated ABNSW score and the neurological examinations.
The endoscopic SN biopsy was performed on 400 patients, and 3D-CT LG on 300 patients. VEM helped to detect precise SN successfully. VEM enable us to identify the anatomical position of SN on axillary node map and to get the second SN easily. BCS was performed on 300 patients and skin-sparing mastectomy on 50 patients. The operative cost is very low as the conventional one. There was no significant difference in operational infestation. There was no serious complication after surgery. The original shapes of the breast were preserved well. The postoperative esthetic results were excellent and better. The complaints after VABS were fewer then the conventional surgery. The numbness of the breast skin was better. All patients expressed great satisfaction.
The esthetic results and QOL of VABS were valuable for practical treatment of the early breast cancer.
Clinical trial identification
All authors have declared no conflicts of interest.