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. 2021 Nov;28(12):7331-7344.
doi: 10.1245/s10434-021-09964-2. Epub 2021 May 1.

Single-Port Three-Dimensional (3D) Videoscope-Assisted Endoscopic Nipple-Sparing Mastectomy in the Management of Breast Cancer: Technique, Clinical Outcomes, Medical Cost, Learning Curve, and Patient-Reported Aesthetic Results from 80 Preliminary Procedures

Hung-Wen Lai  1   2   3   4   5   6   7   8   9   10 , Shou-Tung Chen  11   12   13 , Chi Wei Mok  14   15 , Yun-Ting Chang  11   16 , Shih-Lung Lin  17 , Ying-Jen Lin  18 , Dar-Ren Chen  11   12   13 , Shou-Jen Kuo  12   13
Affiliations

Single-Port Three-Dimensional (3D) Videoscope-Assisted Endoscopic Nipple-Sparing Mastectomy in the Management of Breast Cancer: Technique, Clinical Outcomes, Medical Cost, Learning Curve, and Patient-Reported Aesthetic Results from 80 Preliminary Procedures

Hung-Wen Lai et al. Ann Surg Oncol. 2021 Nov.

Abstract

Background: The preliminary results of an innovative surgical technique, which incorporated single-port three-dimensional (3D) videoscope and instruments for endoscopic nipple-sparing mastectomy (E-NSM), were reported.

Methods: The medical records of patients who underwent single-port 3D E-NSM for breast cancer from August 2018 to September 2020 were analyzed, and the preliminary outcome of this procedure as well as the patient-reported aesthetic results are described in this article.

Results: The study enrolled 70 patients who received 80 procedures of single-port 3D E-NSM. The mean operation time was 158 ± 36 min, and the mean blood loss was 41 ± 26 ml. Three procedures (3.8 %) associated with delayed axillary wound-healing, eight cases of transient nipple ischemia (10 %), three cases of partial nipple ischemia/necrosis (3.7 %), and one case of total nipple-areolar complex (NAC) necrosis (1.3 %) were observed. No patient had margin involvement. Satisfaction rates of approximately 90 % were observed in terms of postoperative scar appearance, location, and length. Most of the patients (87.8 %) reported that they would choose the same operation again if given the chance to do so. The overall cost of a single-port 3D E-NSM was 7522 ± 470 U.S. dollars. According to cumulative sum (CUSUM) plot analysis, about 14 cases were needed for surgeons to familiarize themselves with single-port 3D E-NSM and immediate gel implant reconstruction and to decrease their operation time significantly in the initial learning phase.

Conclusion: Single-port 3D E-NSM, a safe, efficient, lower-cost procedure, is associated with a good aesthetic result. It is a promising new technique for breast cancer patients indicated for mastectomy, but long-term oncologic safety follow-up evaluation still is needed.

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