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.	骆成玉. 微创功能治疗: 乳腺外科临床实践的必然选择. 中华腔镜外科杂志(电子版), 2011, 4(3): 167-171.
2.	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.
3.	陈海军, 韩智培, 翟保平. 乳腺腔镜手术操作空间建立的研究进展. 腹腔镜外科杂志, 2017, 22(9): 709-712.
4.	高国璇, 王红卫, 丁国乾, 等. 单孔充气法腔镜胸肌前一期假体植入乳房重建术临床分析. 国际外科学杂志, 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, 姜军, 杨新华, 等. 吸脂法腔镜腋窝淋巴结清扫术淋巴结组织学改变的临床对照研究. 中华外科杂志, 2007, 45(7): 487-488.
10.	徐威, 王子函, 高国璇, 等. 单孔充气法腔镜乳腺癌保乳手术66例疗效分析. 中国实用外科杂志, 2020, 40(10): 1155-1158.
11.	关山, 王宇, 张开通, 等. 应用皮肤悬吊系统腔镜下保留乳头乳晕乳腺切除即刻乳房重建. 中华外科杂志, 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.	吴鑫, 刘静, 陈莉. 机器人手术系统在乳腺外科的应用进展. 机器人外科学杂志(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.	周娇, 梁法清, 谢妍妍, 等. 华西医院日间腔镜乳腺皮下切除联合一期假体重建的临床路径简介. 中国胸心血管外科临床杂志, 2021, 28(12): 1393-1399.
18.	谢妍妍, 吕青, 杜正贵. 乳腺腔镜和机器人手术的现状及未来之路——华西医院经验分享. 外科理论与实践, 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, 谢妍妍, 等. 腋窝入路腔镜下乳腺癌皮下腺体切除联合胸肌前假体+补片Ⅰ期乳房重建的创新探索. 中国胸心血管外科临床杂志, 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.	邱梦雪, 杨焕佐, 周娇, 等. 基于华西三号孔的腋窝入路腔镜乳腺良性肿瘤切除及恶性肿瘤保乳术技巧与疗效分析. 中国胸心血管外科临床杂志, 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.	张勇, 陈诚, 杨燕文, 等. 假体联合补片即刻乳房再造手术并发症的预防与治疗. 中国医疗美容, 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. 骆成玉. 微创功能治疗: 乳腺外科临床实践的必然选择. 中华腔镜外科杂志(电子版), 2011, 4(3): 167-171.
2. 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.
3. 陈海军, 韩智培, 翟保平. 乳腺腔镜手术操作空间建立的研究进展. 腹腔镜外科杂志, 2017, 22(9): 709-712.
4. 高国璇, 王红卫, 丁国乾, 等. 单孔充气法腔镜胸肌前一期假体植入乳房重建术临床分析. 国际外科学杂志, 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, 姜军, 杨新华, 等. 吸脂法腔镜腋窝淋巴结清扫术淋巴结组织学改变的临床对照研究. 中华外科杂志, 2007, 45(7): 487-488.
10. 徐威, 王子函, 高国璇, 等. 单孔充气法腔镜乳腺癌保乳手术66例疗效分析. 中国实用外科杂志, 2020, 40(10): 1155-1158.
11. 关山, 王宇, 张开通, 等. 应用皮肤悬吊系统腔镜下保留乳头乳晕乳腺切除即刻乳房重建. 中华外科杂志, 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. 吴鑫, 刘静, 陈莉. 机器人手术系统在乳腺外科的应用进展. 机器人外科学杂志(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. 周娇, 梁法清, 谢妍妍, 等. 华西医院日间腔镜乳腺皮下切除联合一期假体重建的临床路径简介. 中国胸心血管外科临床杂志, 2021, 28(12): 1393-1399.
18. 谢妍妍, 吕青, 杜正贵. 乳腺腔镜和机器人手术的现状及未来之路——华西医院经验分享. 外科理论与实践, 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, 谢妍妍, 等. 腋窝入路腔镜下乳腺癌皮下腺体切除联合胸肌前假体+补片Ⅰ期乳房重建的创新探索. 中国胸心血管外科临床杂志, 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. 邱梦雪, 杨焕佐, 周娇, 等. 基于华西三号孔的腋窝入路腔镜乳腺良性肿瘤切除及恶性肿瘤保乳术技巧与疗效分析. 中国胸心血管外科临床杂志, 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. 张勇, 陈诚, 杨燕文, 等. 假体联合补片即刻乳房再造手术并发症的预防与治疗. 中国医疗美容, 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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