Eighteen weapons of endoscopic breast surgery: Application of gas and liquid_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CAO Xiaoman ^1,2 , ZHU Zhongjian ^1,2 , WU Hao ^1,2 , ZHANG Songbo ³ , LIANG Faqing ^1,2 , XIE Yanyan ^1,2 ,  DU Zhenggui ^1,2

1. Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Breast Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Department of Breast Surgery, Sichuan Clinical Research Center forCancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu 610041, P. R. China;

Corresponding author：

DU Zhenggui, Email: docduzg@163.com

Keywords：

breast disease; endoscopic surgery; robotic surgery; gas; liquid

DOI：

10.7507/1007-9424.202502079

Video：

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In conventional open breast surgery, the surgical trauma is significant and the postoperative scar is often noticeable. Endoscopic and robot-assisted breast surgery is increasingly attracting attention due to the advantages such as smaller incisions, lower complication rate, and improved aesthetic outcomes. However, the lack of natural cavities in the breast has become a primary challenge in establishing and maintaining the necessary surgical space for endoscopic breast surgery. We reviewed the research progress of endoscopic and robot-assisted breast surgery, summarized the the innovations and challenges of existing techniques, and focused on introducing the application value of physical and biological properties of gas and liquid in endoscopic breast surgery.

Citation： CAO Xiaoman, ZHU Zhongjian, WU Hao, ZHANG Songbo, LIANG Faqing, XIE Yanyan, DU Zhenggui. Eighteen weapons of endoscopic breast surgery: Application of gas and liquid. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(3): 277-281. doi: 10.7507/1007-9424.202502079 Copy

1.	Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med, 2002, 347(16): 1227-1232.
2.	Chung AP, Sacchini V. Nipple-sparing mastectomy: where are we now?. Surg Oncol, 2008, 17(4): 261-266.
3.	Adams WP, Lipschitz AH, Ansari M, et al. Functional donor site morbidity following latissimus dorsi muscle flap transfer. Ann Plast Surg, 2004, 53(1): 6-11.
4.	Du J, Liang Q, Qi X, et al. Endoscopic nipple sparing mastectomy with immediate implant-based reconstruction versus breast conserving surgery: a long-term study. Sci Rep, 2017, 7: 45636. doi: 10.1038/srep45636.
5.	Feng Y, Wen N, Liang F, et al. Endoscopic nipple- or skin-sparing mastectomy and immediate breast reconstruction with endoscopic harvesting of the latissimus dorsi flap: A preliminary experience of an innovative technique. Breast J, 2022, 2022: 1373899. doi: 10.1155/2022/1373899.
6.	Lai HW, Chen DR, Liu LC, et al. Robotic versus conventional or endoscopic-assisted nipple-sparing mastectomy and immediate prosthesis breast reconstruction in the management of breast cancer: A prospectively designed multicenter trial comparing clinical outcomes, medical cost, and patient-reported outcomes (RCENSM-P). Ann Surg, 2024, 279(1): 138-146.
7.	万安弟, 齐晓伟, 张毅, 等. 乳腺癌微创手术的研究现状与进展. 中国普外基础与临床杂志, 2022, 29(11): 1433-1438.
8.	吴淞, 章佳新. 乳腺腔镜手术操作空间建立的进展分析. 中国继续医学教育, 2020, 12(12): 114-116.
9.	Kompatscher P. Endoscopic capsulotomy of capsular contracture after breast augmentation: a very challenging therapeutic approach. Plast Reconstr Surg, 1992, 90(6): 1125-1126.
10.	Friedlander L, Sundin J. Minimally invasive harvesting of the latissimus dorsi. Plast Reconstr Surg, 1994, 94(6): 881-884.
11.	Nakajima H, Sakaguchi K, Mizuta N, et al. Video-assisted total glandectomy and immediate reconstruction for breast cancer. Biomed Pharmacother, 2002, 56 Suppl 1: 205s-208s. doi: 10.1016/s0753-3322(02)00281-0.
12.	Kitamura K, Ishida M, Inoue H, et al. Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer. Surgery, 2002, 131(1 Suppl): S324-S329. doi: 10.1067/msy.2002.120120.
13.	Sakamoto N, Fukuma E, Higa K, et al. Early results of an endoscopic nipple-sparing mastectomy for breast cancer. Ann Surg Oncol, 2009, 16(12): 3406-3413.
14.	Lai HW, Wu HS, Chuang KL, et al. Endoscopy-assisted total mastectomy followed by immediate pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction: Preliminary results of 48 patients. Surg Innov, 2015, 22(4): 382-389.
15.	Wu QF, Yu YH, Zhu X, et al. Development of video-assisted breast cancer surgery: Initial experience with a novel method for creating working space without prior liposuction. Mol Clin Oncol, 2017, 7(1): 32-38.
16.	刘子腾, 李宗晏, 付晓燕, 等. 腋窝入路腔镜下双侧乳房皮下切除Ⅰ期假体重建术的临床效果. 中国普外基础与临床杂志, 2022, 29(11): 1427-1432.
17.	Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-saring mastectomy: Technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.
18.	Kuo YL, Chang CH, Chang TY, et al. Endoscopy-assisted total mastectomy with and without immediate reconstruction: An extended follow-up, multicenter study. Plast Reconstr Surg, 2021, 147(2): 267-278.
19.	Lee HY, Chang YW, Yu DY, et al. Comparison of single incision endoscopic nipple-sparing mastectomy and conventional nipple-sparing mastectomy for breast cancer based on initial experience. J Breast Cancer, 2021, 24(2): 196-205.
20.	Toesca A, Peradze N, Galimberti V, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with implant: First report of surgical technique. Ann Surg, 2017, 266(2): e28-e30. doi: 10.1097/SLA.0000000000001397.
21.	Feng Y, Xie Y, Liang F, et al. Twenty-four-hour discharge of patients after endoscopic nipple-sparing mastectomy and direct-to-implant breast reconstruction: safety and aesthetic outcomes from a prospective cohort study. Br J Surg, 2024, 111(1): znad356. doi: 10.1093/bjs/znad356.
22.	Chung K, Xie Y, Liang F, et al. Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery. Front Oncol, 2024, 14: 1366877. doi: 10.3389/fonc.2024.1366877.
23.	Zhou J, Xie Y, Liang F, et al. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
24.	Yang H, Liang F, Xie Y, et al. Single axillary incision reverse-order endoscopic nipple/skin-sparing mastectomy followed by subpectoral implant-based breast reconstruction: Technique, clinical outcomes, and aesthetic results from 88 preliminary procedures. Surgery, 2023, 174(3): 464-472.
25.	吕青. 置身事内: 华西乳腺(癌)腔镜手术的开创与发展创新. 中国普外基础与临床杂志, 2022, 29(11): 1405-1414.
26.	Qiu M, Liang F, Xie Y, et al. Clinical outcomes of transaxillary reverse-sequence endoscopic nipple-sparing mastectomy and direct-to-implant prepectoral breast reconstruction: A prospective study of initial 68 procedures. Ann Surg Oncol, 2024, 31(4): 2777-2785.

1. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med, 2002, 347(16): 1227-1232.
2. Chung AP, Sacchini V. Nipple-sparing mastectomy: where are we now?. Surg Oncol, 2008, 17(4): 261-266.
3. Adams WP, Lipschitz AH, Ansari M, et al. Functional donor site morbidity following latissimus dorsi muscle flap transfer. Ann Plast Surg, 2004, 53(1): 6-11.
4. Du J, Liang Q, Qi X, et al. Endoscopic nipple sparing mastectomy with immediate implant-based reconstruction versus breast conserving surgery: a long-term study. Sci Rep, 2017, 7: 45636. doi: 10.1038/srep45636.
5. Feng Y, Wen N, Liang F, et al. Endoscopic nipple- or skin-sparing mastectomy and immediate breast reconstruction with endoscopic harvesting of the latissimus dorsi flap: A preliminary experience of an innovative technique. Breast J, 2022, 2022: 1373899. doi: 10.1155/2022/1373899.
6. Lai HW, Chen DR, Liu LC, et al. Robotic versus conventional or endoscopic-assisted nipple-sparing mastectomy and immediate prosthesis breast reconstruction in the management of breast cancer: A prospectively designed multicenter trial comparing clinical outcomes, medical cost, and patient-reported outcomes (RCENSM-P). Ann Surg, 2024, 279(1): 138-146.
7. 万安弟, 齐晓伟, 张毅, 等. 乳腺癌微创手术的研究现状与进展. 中国普外基础与临床杂志, 2022, 29(11): 1433-1438.
8. 吴淞, 章佳新. 乳腺腔镜手术操作空间建立的进展分析. 中国继续医学教育, 2020, 12(12): 114-116.
9. Kompatscher P. Endoscopic capsulotomy of capsular contracture after breast augmentation: a very challenging therapeutic approach. Plast Reconstr Surg, 1992, 90(6): 1125-1126.
10. Friedlander L, Sundin J. Minimally invasive harvesting of the latissimus dorsi. Plast Reconstr Surg, 1994, 94(6): 881-884.
11. Nakajima H, Sakaguchi K, Mizuta N, et al. Video-assisted total glandectomy and immediate reconstruction for breast cancer. Biomed Pharmacother, 2002, 56 Suppl 1: 205s-208s. doi: 10.1016/s0753-3322(02)00281-0.
12. Kitamura K, Ishida M, Inoue H, et al. Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer. Surgery, 2002, 131(1 Suppl): S324-S329. doi: 10.1067/msy.2002.120120.
13. Sakamoto N, Fukuma E, Higa K, et al. Early results of an endoscopic nipple-sparing mastectomy for breast cancer. Ann Surg Oncol, 2009, 16(12): 3406-3413.
14. Lai HW, Wu HS, Chuang KL, et al. Endoscopy-assisted total mastectomy followed by immediate pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction: Preliminary results of 48 patients. Surg Innov, 2015, 22(4): 382-389.
15. Wu QF, Yu YH, Zhu X, et al. Development of video-assisted breast cancer surgery: Initial experience with a novel method for creating working space without prior liposuction. Mol Clin Oncol, 2017, 7(1): 32-38.
16. 刘子腾, 李宗晏, 付晓燕, 等. 腋窝入路腔镜下双侧乳房皮下切除Ⅰ期假体重建术的临床效果. 中国普外基础与临床杂志, 2022, 29(11): 1427-1432.
17. Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-saring mastectomy: Technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.
18. Kuo YL, Chang CH, Chang TY, et al. Endoscopy-assisted total mastectomy with and without immediate reconstruction: An extended follow-up, multicenter study. Plast Reconstr Surg, 2021, 147(2): 267-278.
19. Lee HY, Chang YW, Yu DY, et al. Comparison of single incision endoscopic nipple-sparing mastectomy and conventional nipple-sparing mastectomy for breast cancer based on initial experience. J Breast Cancer, 2021, 24(2): 196-205.
20. Toesca A, Peradze N, Galimberti V, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with implant: First report of surgical technique. Ann Surg, 2017, 266(2): e28-e30. doi: 10.1097/SLA.0000000000001397.
21. Feng Y, Xie Y, Liang F, et al. Twenty-four-hour discharge of patients after endoscopic nipple-sparing mastectomy and direct-to-implant breast reconstruction: safety and aesthetic outcomes from a prospective cohort study. Br J Surg, 2024, 111(1): znad356. doi: 10.1093/bjs/znad356.
22. Chung K, Xie Y, Liang F, et al. Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery. Front Oncol, 2024, 14: 1366877. doi: 10.3389/fonc.2024.1366877.
23. Zhou J, Xie Y, Liang F, et al. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
24. Yang H, Liang F, Xie Y, et al. Single axillary incision reverse-order endoscopic nipple/skin-sparing mastectomy followed by subpectoral implant-based breast reconstruction: Technique, clinical outcomes, and aesthetic results from 88 preliminary procedures. Surgery, 2023, 174(3): 464-472.
25. 吕青. 置身事内: 华西乳腺(癌)腔镜手术的开创与发展创新. 中国普外基础与临床杂志, 2022, 29(11): 1405-1414.
26. Qiu M, Liang F, Xie Y, et al. Clinical outcomes of transaxillary reverse-sequence endoscopic nipple-sparing mastectomy and direct-to-implant prepectoral breast reconstruction: A prospective study of initial 68 procedures. Ann Surg Oncol, 2024, 31(4): 2777-2785.

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Eighteen weapons of endoscopic breast surgery: Application of gas and liquid

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