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Minimally Invasive (Endoscopic & Robotic) Breast Surgery
Chi Wei Mok, Hung-Wen Lai
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eBook - ePub
Minimally Invasive (Endoscopic & Robotic) Breast Surgery
Chi Wei Mok, Hung-Wen Lai
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About This Book
ā¢ Clinical cases provide a visual resource of surgical options
ā¢ Easy to follow format shows step by step each technique
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Information
Topic
MedicineSubtopic
Surgery & Surgical MedicineEndoscopic or video-assisted breast surgery
Section 1
Endoscopic breast surgery with no reconstruction
Chapter 1
Endoscopic breast-conserving surgery
Abstract
Endoscopic breast-conserving surgery offers a comparable alternative to conventional breast conservation techniques while providing better cosmesis with well-hidden, inconspicuous scars. In the initial development phase of this technique, dual incisions were used whereby an axillary incision was used for sentinel lymph node biopsy as well as dissection of the breast parenchyma off pectoralis major fascia and another periareolar incision for skin flap dissection. Subsequently, changes in technique led to development of a single axillary incision procedure. There are however limitations to the use of a single axillary incision, which will be discussed at the end of this chapter.
Keywords
Breast-conserving surgery; endoscopic; partial mastectomy; video-assisted
Description of technique
Pre-operative marking and positioning
Pre-operative marking was done with the patient in standing and supine position. After induction of general anaesthesia, the patient was then placed in supine position and ipsilateral arm abducted to 90 degrees to avoid affecting the operative procedure. Endoscopic video monitors (Olympus Optical Co., Tokyo, Japan) were set up on both sides of the patient's head to allow both the surgeon and assistant to view the monitor. An oblique-ended rigid endoscope measuring 5 mm in diameter with a viewing angle of 30 degrees was used in all procedures.
Axillary staging procedure
In patients for whom sentinel lymph node biopsy (SLNB) is indicated, a small amount (2ā3 mCi) of radioisotope Tc99m was injected intradermally at the site of the tumour before operation (either on the day or 1 day prior).
After induction of general anaesthesia, 3 mL of 1% methylene blue (Merck, Darmstadt, Germany) was injected into the breast parenchyma in equally divided aliquots at five positions surrounding the hemisphere of the tumour facing the ipsilateral axilla. The breast tissue from the tumour to the axilla was then gently massaged for 5ā10 minutes. Within 20ā30 minutes after injection of the blue dye, a handheld gamma p...