Minimally Invasive (Endoscopic & Robotic) Breast Surgery

Chi Wei Mok, Hung-Wen Lai

• Éditeur: Elsevier
• Année: 2019
• ISBN:
  9780323734066
• Sujet: Medicine
• Sous-sujet: Surgery & Surgical Medicine

• Clinical cases provide a visual resource of surgical options
• Easy to follow format shows step by step each technique

Endoscopic or video-assisted breast surgery

Outline

Section 1. Endoscopic breast surgery with no reconstruction

Chapter 1. Endoscopic breast-conserving surgery

Chapter 2. Endoscopic mastectomy

Section 2. Endoscopic breast conserving surgery with immediate reconstruction

Chapter 3. Endoscopic breast-conserving surgery with immediate omental flap reconstruction

Chapter 4. Endoscopic breast-conserving surgery with immediate local advancement/perforator flap reconstruction

Section 3. Endoscopic mastectomy with immediate reconstruction

Chapter 5. Endoscopic mastectomy with immediate implant reconstruction

Chapter 6. Endoscopic mastectomy with immediate transverse rectus abdominis flap reconstruction

Chapter 7. Endoscopic mastectomy with immediate latissimus dorsi flap reconstruction

Section 1

Endoscopic breast surgery with no reconstruction

Outline

Chapter 1. Endoscopic breast-conserving surgery

Chapter 2. Endoscopic mastectomy

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 (2–3 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 5–10 minutes. Within 20–30 minutes after injection of the blue dye, a handheld gamma p...