Past and present of endoscopic surgery and robotic surgery in treatment of breast diseases_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Qing ^1,2 , XIE Yanyan ^1,2 , LIANG Faqing ^1,2 , FENG Yu ³ ,  DU Zhenggui ^1,2

1. Department of General Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Breast Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
3. Department of General Surgery, the Fourth People’s Hospital of Sichuan Province, Chengdu Sichuan, 610020, P. R. China;

Corresponding?author：

DU Zhenggui, Email: docduzg@163.com

Keywords：

Breast disease; endoscopic surgery; robotic surgery; minimally invasive

DOI：

10.7507/1002-1892.202404034

Video：

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Objective To review the research progress related to endoscopic surgery and robotic surgery for breast diseases, aiming to provide references for clinical practice. Methods The recent domestic and international literature on endoscopic surgery and robotic surgery for breast diseases was reviewed, then the challenges in their development, the innovative evolution of endoscopic surgery combined with clinical practice by our team, and its clinical applications were summarized. Results Traditional endoscopic surgery, despite its advantages such as minimal invasiveness, good cosmetic outcomes, and high patient’s satisfaction, has been limited in its development due to specific difficulties in establishing the operative field. Our team innovatively proposed the “reverse sequence method” and the Huaxi Hole 1 theory and methods, cleverly altering the surgical procedure sequence, adding small operative orifices to transform single-port operations into multi-port ones, effectively overcoming the challenges restricting the advancement of endoscopic surgery in the field of breast diseases, thereby enabling further proliferation of endoscopic procedures. In terms of breast endoscopic reconstruction surgery, the parachute patch technique has broadened the indications for reconstruction surgery, benefiting patients with a certain degree of breast ptosis; and the postoperative adjustment concept, through early intervention in the post-reconstruction breast shape, has further refined the reconstruction procedure. Robot-assisted surgery derived from endoscopic surgery theory has further enhanced the precision and stability of surgeries, reducing surgical risks; however, excessive time and economic costs are urgent issues that must be addressed. Conclusion Through theoretical innovations, endoscopic surgery has been applied in the excision and reconstruction of breast lesions, while robotic surgery shows promising applications in autologous breast reconstruction, especially in the latissimus dorsi reconstruction field. Nevertheless, the lack of high-level large-sample, multi-center randomized controlled clinical trials to confirm its surgical safety, oncological safety, and postoperative cosmetic outcomes is an important direction for future research.

Citation： ZHANG Qing, XIE Yanyan, LIANG Faqing, FENG Yu, DU Zhenggui. Past and present of endoscopic surgery and robotic surgery in treatment of breast diseases. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(7): 769-775. doi: 10.7507/1002-1892.202404034 Copy

1.	駱成玉. 微創功能治療: 乳腺外科臨床實踐的必然選擇. 中華腔鏡外科雜志(電子版), 2011, 4(3): 167-171.
2.	吳淞, 章佳新. 乳腺腔鏡手術操作空間建立的進展分析. 中國繼續醫學教育, 2020, 12(12): 114-116.
3.	陳海軍, 韓智培, 翟保平. 乳腺腔鏡手術操作空間建立的研究進展. 腹腔鏡外科雜志, 2017, 22(9): 709-712.
4.	高國璇, 王紅衛, 丁國乾, 等. 單孔充氣法腔鏡胸肌前一期假體植入乳房重建術臨床分析. 國際外科學雜志, 2022, 49(3): 168-174, C2.
5.	Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.
6.	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.
7.	Malur S, Bechler J, Schneider A. Endoscopic axillary lymphadenectomy without prior liposuction in 100 patients with invasive breast cancer. Surg Laparosc Endosc Percutan Tech, 2001, 11(1): 38-42.
8.	Luo C, Guo W, Yang J, et al. Comparison of mastoscopic and conventional axillary lymph node dissection in breast cancer: long-term results from a randomized, multicenter trial. Mayo Clin Proc, 2012, 87 (12): 1153-1161.
9.	郭美琴, 姜軍, 楊新華, 等. 吸脂法腔鏡腋窩淋巴結清掃術淋巴結組織學改變的臨床對照研究. 中華外科雜志, 2007, 45(7): 487-488.
10.	徐威, 王子函, 高國璇, 等. 單孔充氣法腔鏡乳腺癌保乳手術66例療效分析. 中國實用外科雜志, 2020, 40(10): 1155-1158.
11.	關山, 王宇, 張開通, 等. 應用皮膚懸吊系統腔鏡下保留乳頭乳暈乳腺切除即刻乳房重建. 中華外科雜志, 2017, 55(2): 126-129.
12.	Morrell ALG, Morrell-Junior AC, Morrell AG, et al. The history of robotic surgery and its evolution: when illusion becomes reality. Rev Col Bras Cir, 2021, 48: e20202798. doi: 10.1590/0100-6991e-20202798.
13.	Yu HY, Friedlander DF, Patel S, et al. The current status of robotic oncologic surgery. CA Cancer J Clin, 2013, 63(1): 45-56.
14.	吳鑫, 劉靜, 陳莉. 機器人手術系統在乳腺外科的應用進展. 機器人外科學雜志(中英文), 2023, 4(3): 186-192.
15.	Toesca A, Peradze N, Galimberti V, et al. Robotic nipple sparing mastectomy for the treatment of breast cancer: feasibility and safety study. Breast, 2017, 31: 51-56.
16.	Lai HW, Chen ST, Lin SL, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with gel implant: technique, preliminary results and patient-reported cosmetic outcomes. Ann Surg Oncol, 2019, 26(1): 42-52.
17.	周嬌, 梁法清, 謝妍妍, 等. 華西醫院日間腔鏡乳腺皮下切除聯合一期假體重建的臨床路徑簡介. 中國胸心血管外科臨床雜志, 2021, 28(12): 1393-1399.
18.	謝妍妍, 呂青, 杜正貴. 乳腺腔鏡和機器人手術的現狀及未來之路——華西醫院經驗分享. 外科理論與實踐, 2022, 27(5): 396-402.
19.	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.
20.	覃湘泉, 王甜甜, 謝妍妍, 等. 腋窩入路腔鏡下乳腺癌皮下腺體切除聯合胸肌前假體+補片Ⅰ期乳房重建的創新探索. 中國胸心血管外科臨床雜志, 2021, 28(9): 1029-1036.
21.	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.
22.	邱夢雪, 楊煥佐, 周嬌, 等. 基于華西三號孔的腋窩入路腔鏡乳腺良性腫瘤切除及惡性腫瘤保乳術技巧與療效分析. 中國胸心血管外科臨床雜志, 2023, 30(3): 350-356.
23.	Casella D, Bernini M, Bencini L, et al. TiLoop^? Bra mesh used for immediate breast reconstruction: comparison of retropectoral and subcutaneous implant placement in a prospective single-institution series. Eur J Plast Surg, 2014, 37(11): 599-604.
24.	張勇, 陳誠, 楊燕文, 等. 假體聯合補片即刻乳房再造手術并發癥的預防與治療. 中國醫療美容, 2022, 12(11): 4-7.
25.	Lai HW, Chen ST, Lin SL, et al. Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer: A case report. Medicine (Baltimore), 2018, 97(27): e11373. doi: 10.1097/MD.0000000000011373.
26.	Gundlapalli VS, Ogunleye AA, Scott K, et al. Robotic-assisted deep inferior epigastric artery perforator flap abdominal harvest for breast reconstruction: A case report. Microsurgery, 2018, 38(6): 702-705.
27.	Feng Y, Liang F, Wen N, et al. An innovative and highly efficient single-port endoscopic nipple-/skin-sparing mastectomy and dual-plane direct-to-implant breast reconstruction: a prospective study from a single institution. Aesthetic Plast Surg, 2024, 48(6): 1133-1141.
28.	Qiu M, Yang H, Zhou J, et al. Short-term safety and cosmetic outcomes of endoscopic direct-to-implant breast reconstruction and simultaneous contralateral breast augmentation for breast cancer: a prospective analysis of 33 patients. World J Surg Oncol, 2023, 21(1): 201. doi: 10.1186/s12957-023-03089-4.
29.	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.
30.	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.
31.	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.

1. 駱成玉. 微創功能治療: 乳腺外科臨床實踐的必然選擇. 中華腔鏡外科雜志(電子版), 2011, 4(3): 167-171.
2. 吳淞, 章佳新. 乳腺腔鏡手術操作空間建立的進展分析. 中國繼續醫學教育, 2020, 12(12): 114-116.
3. 陳海軍, 韓智培, 翟保平. 乳腺腔鏡手術操作空間建立的研究進展. 腹腔鏡外科雜志, 2017, 22(9): 709-712.
4. 高國璇, 王紅衛, 丁國乾, 等. 單孔充氣法腔鏡胸肌前一期假體植入乳房重建術臨床分析. 國際外科學雜志, 2022, 49(3): 168-174, C2.
5. Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.
6. 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.
7. Malur S, Bechler J, Schneider A. Endoscopic axillary lymphadenectomy without prior liposuction in 100 patients with invasive breast cancer. Surg Laparosc Endosc Percutan Tech, 2001, 11(1): 38-42.
8. Luo C, Guo W, Yang J, et al. Comparison of mastoscopic and conventional axillary lymph node dissection in breast cancer: long-term results from a randomized, multicenter trial. Mayo Clin Proc, 2012, 87 (12): 1153-1161.
9. 郭美琴, 姜軍, 楊新華, 等. 吸脂法腔鏡腋窩淋巴結清掃術淋巴結組織學改變的臨床對照研究. 中華外科雜志, 2007, 45(7): 487-488.
10. 徐威, 王子函, 高國璇, 等. 單孔充氣法腔鏡乳腺癌保乳手術66例療效分析. 中國實用外科雜志, 2020, 40(10): 1155-1158.
11. 關山, 王宇, 張開通, 等. 應用皮膚懸吊系統腔鏡下保留乳頭乳暈乳腺切除即刻乳房重建. 中華外科雜志, 2017, 55(2): 126-129.
12. Morrell ALG, Morrell-Junior AC, Morrell AG, et al. The history of robotic surgery and its evolution: when illusion becomes reality. Rev Col Bras Cir, 2021, 48: e20202798. doi: 10.1590/0100-6991e-20202798.
13. Yu HY, Friedlander DF, Patel S, et al. The current status of robotic oncologic surgery. CA Cancer J Clin, 2013, 63(1): 45-56.
14. 吳鑫, 劉靜, 陳莉. 機器人手術系統在乳腺外科的應用進展. 機器人外科學雜志(中英文), 2023, 4(3): 186-192.
15. Toesca A, Peradze N, Galimberti V, et al. Robotic nipple sparing mastectomy for the treatment of breast cancer: feasibility and safety study. Breast, 2017, 31: 51-56.
16. Lai HW, Chen ST, Lin SL, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with gel implant: technique, preliminary results and patient-reported cosmetic outcomes. Ann Surg Oncol, 2019, 26(1): 42-52.
17. 周嬌, 梁法清, 謝妍妍, 等. 華西醫院日間腔鏡乳腺皮下切除聯合一期假體重建的臨床路徑簡介. 中國胸心血管外科臨床雜志, 2021, 28(12): 1393-1399.
18. 謝妍妍, 呂青, 杜正貴. 乳腺腔鏡和機器人手術的現狀及未來之路——華西醫院經驗分享. 外科理論與實踐, 2022, 27(5): 396-402.
19. 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.
20. 覃湘泉, 王甜甜, 謝妍妍, 等. 腋窩入路腔鏡下乳腺癌皮下腺體切除聯合胸肌前假體+補片Ⅰ期乳房重建的創新探索. 中國胸心血管外科臨床雜志, 2021, 28(9): 1029-1036.
21. 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.
22. 邱夢雪, 楊煥佐, 周嬌, 等. 基于華西三號孔的腋窩入路腔鏡乳腺良性腫瘤切除及惡性腫瘤保乳術技巧與療效分析. 中國胸心血管外科臨床雜志, 2023, 30(3): 350-356.
23. Casella D, Bernini M, Bencini L, et al. TiLoop^? Bra mesh used for immediate breast reconstruction: comparison of retropectoral and subcutaneous implant placement in a prospective single-institution series. Eur J Plast Surg, 2014, 37(11): 599-604.
24. 張勇, 陳誠, 楊燕文, 等. 假體聯合補片即刻乳房再造手術并發癥的預防與治療. 中國醫療美容, 2022, 12(11): 4-7.
25. Lai HW, Chen ST, Lin SL, et al. Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer: A case report. Medicine (Baltimore), 2018, 97(27): e11373. doi: 10.1097/MD.0000000000011373.
26. Gundlapalli VS, Ogunleye AA, Scott K, et al. Robotic-assisted deep inferior epigastric artery perforator flap abdominal harvest for breast reconstruction: A case report. Microsurgery, 2018, 38(6): 702-705.
27. Feng Y, Liang F, Wen N, et al. An innovative and highly efficient single-port endoscopic nipple-/skin-sparing mastectomy and dual-plane direct-to-implant breast reconstruction: a prospective study from a single institution. Aesthetic Plast Surg, 2024, 48(6): 1133-1141.
28. Qiu M, Yang H, Zhou J, et al. Short-term safety and cosmetic outcomes of endoscopic direct-to-implant breast reconstruction and simultaneous contralateral breast augmentation for breast cancer: a prospective analysis of 33 patients. World J Surg Oncol, 2023, 21(1): 201. doi: 10.1186/s12957-023-03089-4.
29. 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.
30. 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.
31. 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.

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