The initiation and innovative development of the endoscopic breast cancer surgery in West China Hospital_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LÜ Qing

Center of Breast, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LÜ Qing, Email: lqlq1963@163.com

Keywords：

mammary gland; breast cancer; endoscopic technique; breast reconstruction

DOI：

10.7507/1007-9424.202210082

Video：

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Abstract Full text Figures/Tables Video References Cited by

Endoscopic technique is one of the important development directions of modern surgical techniques. Compared with the laparoscopic and thoracoscopic surgery, the development of endoscopic technology in breast surgery is generally slow due to the limitation of the physiological structure of this organ. The characteristics of endoscopic technology such as micro-incision trauma and remote operation are especially suitable for breast (cancer) surgery, which desires flawless skin surface and perfect remodeling. In the meantime, however, the obstacles of breast (cancer) endoscopic surgery include the establishment and maintenance of a satisfactory surgical field, the endoscopic exposure of large and heavy glands, the obstruction by the slope of the skeletal thorax, the remote operation that is difficult to accomplish with conventional endoscopic instruments, and the complete removal of large and tough glands and so on. By studying and pondering the experience of the pioneers of endoscopy, the endoscopic team of West China Hospital took five years to develop this novel one axillary-incision, single-port and liposuction-free endoscopic surgical approach which is low costing and only requires one-port operation platform. The original “inverse sequence method”, “Huaxi hole no. 1, 2, 3” and other endoscopy-assisted approach overcome the aforesaid obstacles. It has significantly reduced the technical threshold and operational difficulty of breast (cancer) endoscopic surgery and contributed our own wisdom to the vigorous development of breast endoscopic technology in China. The author shared her observations and thoughts on the technical details of breast endoscopic surgery based on her nearly 20 years of experience in endoscopic operation.

Citation： LÜ Qing. The initiation and innovative development of the endoscopic breast cancer surgery in West China Hospital. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(11): 1405-1414. doi: 10.7507/1007-9424.202210082 Copy

1.	Wang Y, Hong Y, Wang Y, et al. Automated multimodal machine learning for esophageal variceal bleeding prediction based on endoscopy and structured data. J Digit Imaging, 2022 Oct 24. doi: 10.1007/s10278-022-00724-6.
2.	Chen D, Kang P, Tao S, et al. Cost-effectiveness evaluation of robotic-assisted thoracoscopic surgery versus open thoracotomy and video-assisted thoracoscopic surgery for operable non-small cell lung cancer. Lung Cancer, 2021, 153: 99-107.
3.	Guillonneau B, Gupta R, El Fettouh H, et al. Laparoscopic [correction of laproscopic] management of rectal injury during laparoscopic [correction of laproscopic] radical prostatectomy. J Urol, 2003, 169(5): 1694-1696.
4.	Kang BH, Xuan Y, Hur H, et al. Comparison of surgical outcomes between robotic and laparoscopic gastrectomy for gastric cancer: the learning curve of robotic surgery. J Gastric Cancer, 2012, 12(3): 156-163.
5.	Razdan S, Silberstein IK, Bagley DH. Ureteroscopic endoureterotomy. BJU Int, 2005, 95 Suppl 2: 94-101.
6.	Kompatscher P. Endoscopic capsulotomy of capsular contracture after breast augmentation: a very challenging therapeutic approach. Plast Reconstr Surg, 1992, 90(6): 1125-1126.
7.	Salvat J, Knopf JF, Ayoubi JM, et al. Endoscopic exploration and lymph node sampling of the axilla. Preliminary findings of a randomized pilot study comparing clinical and anatomo-pathologic results of endoscopic axillary lymph node sampling with traditional surgical treatment. Eur J Obstet Gynecol Reprod Biol, 1996, 70(2): 165-173.
8.	Friedlander LD, Sundin J, Bakshandeh N. Endoscopy mastectomy and breast reconstruction: endoscopic breast surgery. Aesthetic Plast Surg, 1995, 19(1): 27-29.
9.	Tamaki Y, Sakita I, Miyoshi Y, et al. Transareolar endoscopy-assisted partial mastectomy: a preliminary report of six cases. Surg Laparosc Endosc Percutan Tech, 2001, 11(6): 356-362.
10.	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.
11.	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.
12.	Kelling G. Uber Oesophagoeskopie, Gastroskopie und Colioskopie. Munch Med Wochenschr, 1901, 49: 21-24. .
13.	Ott D. Die direkte Beleuchtung der Bauchhöhle, der Harn blase, des Dickdarms, und des Uterus zu diagnostischen Zwecken. Rev Med Tcheque, 1909, 2: 27-30.
14.	Kelling G. Zur Coelioskopie. Arch Klin Chir, 1923, 126: 226-229.
15.	Fermelia D, Berci G. Diagnostic and therapeutic laparoscopy. An entity often overlooked by the surgeon. Surg Endosc, 1987, 1(2): 73-77.
16.	Gaskin TA, Isobe JH, Mathews JL, et al. Laparoscopy and the general surgeon. Surg Clin North Am, 1991, 71(5): 1085-1097.
17.	Spaner SJ, Warnock GL. A brief history of endoscopy, laparoscopy, and laparoscopic surgery. J Laparoendosc Adv Surg Tech A, 1997, 7(6): 369-373.
18.	Litynski GS. Kurt Semm and the fight against skepticism: endoscopic hemostasis, laparoscopic appendectomy, and Semm’s impact on the “laparoscopic revolution”. JSLS, 1998, 2(3): 309-313.
19.	Litynski GS. Erich Mühe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS, 1998, 2(4): 341-346.
20.	Mouret P. Celioscopic surgery. Evolution or revolution? Chirurgie, 1990, 116(10): 829-32; discussion 832-833.
21.	荀祖武, 方登华, 方荣新, 等. 电视腹腔镜胆囊切除术100例报告. 中华外科杂志, 1991, 29(10): 616-618.
22.	Friedlander L, Sundin J. Minimally invasive harvesting of the latissimus dorsi. Plast Reconstr Surg, 1994, 94(6): 881-884.
23.	Suzanne F, Emering C, Wattiez A, et al. Axillary lymphadenectomy by lipo-aspiration and endoscopic picking. Apropos of 72 cases. Chirurgie, 1997, 122(2): 138-142; discussion 142-143.
24.	Kitamura K, Hashizume M, Kataoka A, et al. Transaxillary approach for the endoscopic extirpation of benign breast tumors. Surg Laparosc Endosc, 1998, 8(4): 277-279.
25.	Kamprath S, Bechler J, Kühne-Heid R, et al. Endoscopic axillary lymphadenectomy without prior liposuction. Development of a technique and initial experience. Surg Endosc, 1999, 13(12): 1226-1229.
26.	Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-sparing mastectomy: Technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.
27.	郑民华, 李亚芬, 蒋渝, 等. 腋腔镜腋窝淋巴结清扫术. 中国内镜杂志, 1997, 3(6): 14, 16, 85.
28.	骆成玉, 薛镭, 林华, 等. 乳腔镜微小隐蔽切口切除乳腺良性肿块的临床观察. 中华医学杂志, 2003, 83(14): 1233-1235.
29.	骆成玉, 张键, 林华, 等. 电视乳腔镜乳腺癌腋窝淋巴结清扫86例临床分析. 中华医学杂志, 2003, 83(22): 1946-1948.
30.	骆成玉, 张键, 林华, 等. 乳腔镜辅助乳腺癌保乳和完全腔镜腋窝淋巴结清扫手术. 实用临床医药杂志, 2003, 7(5): 414-417.
31.	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.
32.	姜军, 杨新华, 范林军, 等. 腔镜手术在乳腺疾病外科治疗中的应用. 中华医学杂志, 2005, 85(3): 181-183.
33.	范林军, 姜军. 全腔镜乳腺癌改良根治手术技术. 中华乳腺病杂志 (电子版), 2010, 4(1): 17-26.
34.	范林军, 姜军, 杨新华, 等. 全腔镜乳腺癌皮下腺体切除一期假体植入乳房重建. 中国微创外科杂志, 2008, 8(6): 484-487.
35.	范林军, 姜军, 杨新华, 等. 全腔镜乳房皮下腺体切除术: 附96例报告. 中华乳腺病杂志 (电子版), 2008, 2(4): 407-416.
36.	范林军, 姜军, 杨新华, 等. 腔镜辅助乳房皮下切除假体植入一期乳房重建21例. 第三军医大学学报, 2007, 29(16): 1627-1629.
37.	郭美琴, 姜军, 杨新华, 等. 腔镜辅助小切口乳腺癌改良根治术 (附47例报告). 中国实用外科杂志, 2005, 25(10): 607-610.
38.	Wan A, Liang Y, Chen L, et al. Association of long-term oncologic prognosis with minimal access breast surgery vs conventional breast surgery. JAMA Surg, 2022: e224711. doi: 10.1001/jamasurg.2022.4711.
39.	王子函, 滕长胜, 葛智成, 等. 全腔镜乳房皮下腺体切除术加腔镜前哨淋巴结活检术治疗乳腺癌的临床应用. 临床和实验医学杂志, 2015, 14(15): 1297-1300, 1301.
40.	屈翔, 王子函, 王劲夫, 等. 腔镜手术在乳腺癌外科的应用与前景. 中国实用外科杂志, 2018, 38(11): 1245-1248.
41.	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.
42.	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.
43.	Zhang S, Xie Y, Liang F, et al. Video-assisted transaxillary nipple-sparing mastectomy and immediate implant-based breast reconstruction: A novel and promising method. Aesthetic Plast Surg, 2022, 46(1): 91-98.
44.	Qiu J, Wen N, Xie Y, et al. Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery. Gland Surg, 2022, 11(8): 1383-1394.
45.	Zhou J, Liu X, Feng Y, et al. Breakthrough in breast reconstruction in the context of COVID-19: safety and efficiency of endoscopic breast reconstruction at a day surgery center. Gland Surg, 2021, 10(8): 2477-2489.
46.	中国抗癌协会乳腺癌专业委员会, 中国医师协会外科医师分会乳腺外科医师委员会, 上海市抗癌协会乳腺癌专业委员会. 乳腺肿瘤整形与乳房重建专家共识 (2022年版). 中国癌症杂志, 2022, 32(9): 836-924.
47.	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): 38-41, discussion 42.
48.	Wang ZH, Ding G, Wu S, et al. Oncological outcome of single-port insufflation endoscopic nipple-sparing mastectomy versus open mastectomy in early breast cancer patients: a study protocol for a randomised controlled trial. BMJ Open, 2022, 12(5): e047866. doi: 10.1136/bmjopen-2020-047866.
49.	刘立加. 乳腔镜手术治疗乳腺癌的安全性以及近期疗效的评估. 中外医学研究, 2012, 10(2): 10-11.
50.	DeLong MR, Tandon VJ, Bertrand AA, et al. Review of outcomes in prepectoral prosthetic breast reconstruction with and without surgical mesh assistance. Plast Reconstr Surg, 2021, 147(2): 305-315.

1. Wang Y, Hong Y, Wang Y, et al. Automated multimodal machine learning for esophageal variceal bleeding prediction based on endoscopy and structured data. J Digit Imaging, 2022 Oct 24. doi: 10.1007/s10278-022-00724-6.
2. Chen D, Kang P, Tao S, et al. Cost-effectiveness evaluation of robotic-assisted thoracoscopic surgery versus open thoracotomy and video-assisted thoracoscopic surgery for operable non-small cell lung cancer. Lung Cancer, 2021, 153: 99-107.
3. Guillonneau B, Gupta R, El Fettouh H, et al. Laparoscopic [correction of laproscopic] management of rectal injury during laparoscopic [correction of laproscopic] radical prostatectomy. J Urol, 2003, 169(5): 1694-1696.
4. Kang BH, Xuan Y, Hur H, et al. Comparison of surgical outcomes between robotic and laparoscopic gastrectomy for gastric cancer: the learning curve of robotic surgery. J Gastric Cancer, 2012, 12(3): 156-163.
5. Razdan S, Silberstein IK, Bagley DH. Ureteroscopic endoureterotomy. BJU Int, 2005, 95 Suppl 2: 94-101.
6. Kompatscher P. Endoscopic capsulotomy of capsular contracture after breast augmentation: a very challenging therapeutic approach. Plast Reconstr Surg, 1992, 90(6): 1125-1126.
7. Salvat J, Knopf JF, Ayoubi JM, et al. Endoscopic exploration and lymph node sampling of the axilla. Preliminary findings of a randomized pilot study comparing clinical and anatomo-pathologic results of endoscopic axillary lymph node sampling with traditional surgical treatment. Eur J Obstet Gynecol Reprod Biol, 1996, 70(2): 165-173.
8. Friedlander LD, Sundin J, Bakshandeh N. Endoscopy mastectomy and breast reconstruction: endoscopic breast surgery. Aesthetic Plast Surg, 1995, 19(1): 27-29.
9. Tamaki Y, Sakita I, Miyoshi Y, et al. Transareolar endoscopy-assisted partial mastectomy: a preliminary report of six cases. Surg Laparosc Endosc Percutan Tech, 2001, 11(6): 356-362.
10. 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.
11. 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.
12. Kelling G. Uber Oesophagoeskopie, Gastroskopie und Colioskopie. Munch Med Wochenschr, 1901, 49: 21-24. .
13. Ott D. Die direkte Beleuchtung der Bauchhöhle, der Harn blase, des Dickdarms, und des Uterus zu diagnostischen Zwecken. Rev Med Tcheque, 1909, 2: 27-30.
14. Kelling G. Zur Coelioskopie. Arch Klin Chir, 1923, 126: 226-229.
15. Fermelia D, Berci G. Diagnostic and therapeutic laparoscopy. An entity often overlooked by the surgeon. Surg Endosc, 1987, 1(2): 73-77.
16. Gaskin TA, Isobe JH, Mathews JL, et al. Laparoscopy and the general surgeon. Surg Clin North Am, 1991, 71(5): 1085-1097.
17. Spaner SJ, Warnock GL. A brief history of endoscopy, laparoscopy, and laparoscopic surgery. J Laparoendosc Adv Surg Tech A, 1997, 7(6): 369-373.
18. Litynski GS. Kurt Semm and the fight against skepticism: endoscopic hemostasis, laparoscopic appendectomy, and Semm’s impact on the “laparoscopic revolution”. JSLS, 1998, 2(3): 309-313.
19. Litynski GS. Erich Mühe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS, 1998, 2(4): 341-346.
20. Mouret P. Celioscopic surgery. Evolution or revolution? Chirurgie, 1990, 116(10): 829-32; discussion 832-833.
21. 荀祖武, 方登华, 方荣新, 等. 电视腹腔镜胆囊切除术100例报告. 中华外科杂志, 1991, 29(10): 616-618.
22. Friedlander L, Sundin J. Minimally invasive harvesting of the latissimus dorsi. Plast Reconstr Surg, 1994, 94(6): 881-884.
23. Suzanne F, Emering C, Wattiez A, et al. Axillary lymphadenectomy by lipo-aspiration and endoscopic picking. Apropos of 72 cases. Chirurgie, 1997, 122(2): 138-142; discussion 142-143.
24. Kitamura K, Hashizume M, Kataoka A, et al. Transaxillary approach for the endoscopic extirpation of benign breast tumors. Surg Laparosc Endosc, 1998, 8(4): 277-279.
25. Kamprath S, Bechler J, Kühne-Heid R, et al. Endoscopic axillary lymphadenectomy without prior liposuction. Development of a technique and initial experience. Surg Endosc, 1999, 13(12): 1226-1229.
26. Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-sparing mastectomy: Technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.
27. 郑民华, 李亚芬, 蒋渝, 等. 腋腔镜腋窝淋巴结清扫术. 中国内镜杂志, 1997, 3(6): 14, 16, 85.
28. 骆成玉, 薛镭, 林华, 等. 乳腔镜微小隐蔽切口切除乳腺良性肿块的临床观察. 中华医学杂志, 2003, 83(14): 1233-1235.
29. 骆成玉, 张键, 林华, 等. 电视乳腔镜乳腺癌腋窝淋巴结清扫86例临床分析. 中华医学杂志, 2003, 83(22): 1946-1948.
30. 骆成玉, 张键, 林华, 等. 乳腔镜辅助乳腺癌保乳和完全腔镜腋窝淋巴结清扫手术. 实用临床医药杂志, 2003, 7(5): 414-417.
31. 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.
32. 姜军, 杨新华, 范林军, 等. 腔镜手术在乳腺疾病外科治疗中的应用. 中华医学杂志, 2005, 85(3): 181-183.
33. 范林军, 姜军. 全腔镜乳腺癌改良根治手术技术. 中华乳腺病杂志 (电子版), 2010, 4(1): 17-26.
34. 范林军, 姜军, 杨新华, 等. 全腔镜乳腺癌皮下腺体切除一期假体植入乳房重建. 中国微创外科杂志, 2008, 8(6): 484-487.
35. 范林军, 姜军, 杨新华, 等. 全腔镜乳房皮下腺体切除术: 附96例报告. 中华乳腺病杂志 (电子版), 2008, 2(4): 407-416.
36. 范林军, 姜军, 杨新华, 等. 腔镜辅助乳房皮下切除假体植入一期乳房重建21例. 第三军医大学学报, 2007, 29(16): 1627-1629.
37. 郭美琴, 姜军, 杨新华, 等. 腔镜辅助小切口乳腺癌改良根治术 (附47例报告). 中国实用外科杂志, 2005, 25(10): 607-610.
38. Wan A, Liang Y, Chen L, et al. Association of long-term oncologic prognosis with minimal access breast surgery vs conventional breast surgery. JAMA Surg, 2022: e224711. doi: 10.1001/jamasurg.2022.4711.
39. 王子函, 滕长胜, 葛智成, 等. 全腔镜乳房皮下腺体切除术加腔镜前哨淋巴结活检术治疗乳腺癌的临床应用. 临床和实验医学杂志, 2015, 14(15): 1297-1300, 1301.
40. 屈翔, 王子函, 王劲夫, 等. 腔镜手术在乳腺癌外科的应用与前景. 中国实用外科杂志, 2018, 38(11): 1245-1248.
41. 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.
42. 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.
43. Zhang S, Xie Y, Liang F, et al. Video-assisted transaxillary nipple-sparing mastectomy and immediate implant-based breast reconstruction: A novel and promising method. Aesthetic Plast Surg, 2022, 46(1): 91-98.
44. Qiu J, Wen N, Xie Y, et al. Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery. Gland Surg, 2022, 11(8): 1383-1394.
45. Zhou J, Liu X, Feng Y, et al. Breakthrough in breast reconstruction in the context of COVID-19: safety and efficiency of endoscopic breast reconstruction at a day surgery center. Gland Surg, 2021, 10(8): 2477-2489.
46. 中国抗癌协会乳腺癌专业委员会, 中国医师协会外科医师分会乳腺外科医师委员会, 上海市抗癌协会乳腺癌专业委员会. 乳腺肿瘤整形与乳房重建专家共识 (2022年版). 中国癌症杂志, 2022, 32(9): 836-924.
47. 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): 38-41, discussion 42.
48. Wang ZH, Ding G, Wu S, et al. Oncological outcome of single-port insufflation endoscopic nipple-sparing mastectomy versus open mastectomy in early breast cancer patients: a study protocol for a randomised controlled trial. BMJ Open, 2022, 12(5): e047866. doi: 10.1136/bmjopen-2020-047866.
49. 刘立加. 乳腔镜手术治疗乳腺癌的安全性以及近期疗效的评估. 中外医学研究, 2012, 10(2): 10-11.
50. DeLong MR, Tandon VJ, Bertrand AA, et al. Review of outcomes in prepectoral prosthetic breast reconstruction with and without surgical mesh assistance. Plast Reconstr Surg, 2021, 147(2): 305-315.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The initiation and innovative development of the endoscopic breast cancer surgery in West China Hospital

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