Endoscopy-assisted surgery for the management of benign breast tumors: technique, learning curve, and patient-reported outcome from preliminary 323 procedures.
BACKGROUND
Endoscopy-assisted breast surgery (EABS), a technique that optimizes cosmetic outcome because it is performed through small wounds hidden in inconspicuous areas, could be an alternative surgical technique for benign breast tumors. In this study, we report the preliminary results of 323 EABS procedures performed at our institution for the management of benign breast tumors.


METHODS
The medical records of patients who underwent EABS for benign breast lesions during the periods August 2010 to December 2015 were collected from the Changhua Christian Hospital EABS database. Data on clinicopathologic characteristics, type of surgery, hospital stay, and complications were analyzed to determine the effectiveness of the procedure for benign breast tumors. The operating time with the number of procedure performed was analyzed for learning curve evaluation. Patient satisfaction with cosmetic outcome was evaluated with a self-report questionnaire.


RESULTS
A total of 323 EABS procedures were performed in 286 patients with benign breast lesions, including 249 (90.5%) patients with unilateral lesions. The mean age was 36 years, the mean tumor size was 2.2 cm, and the mean distance from the nipple to the tumor was 5.2 cm. Most (93.8%, 303/323) of these tumors were excised through a transareolar wound, 2.4% (8/323) through an axillary wound, and 0.3% (1/323) through the infra-mammary fold. Histopathologic analysis revealed that 63.5% (202/318) of the tumors were fibroadenoma-related lesions. The mean operative time was 81.4 min (59~89 min), which was decreased with experience increased. The overall rate of complications was 6.5%, and all were minor and wound-related. Among the 110 patients who participated in the self-report cosmetic outcome evaluation, 85.4% reported being satisfied with the cosmetic result, and almost all were satisfied with breast symmetry. Of the patients interviewed, 92.7% reported that they would choose the same procedure if they had to undergo the operation again.


CONCLUSIONS
Our preliminary results show that transareolar video-assisted breast surgery is a safe and effective procedure with good cosmetic outcome and that it could be appropriate for patients with moderate to large peripherally located breast tumors.


TRIAL REGISTRATION
CCH-IRB No.15115. Registered 14 December 2015 (retrospectively registered).
['Lai|Hung-Wen|HW|http://orcid.org/0000-0003-0197-6075', 'Lin|Hui-Yu|HY|', 'Chen|Shu-Ling|SL|', 'Chen|Shou-Tung|ST|', 'Chen|Dar-Ren|DR|', 'Kuo|Shou-Jen|SJ|']
D000293:Adolescent D000328:Adult D000368:Aged D001940:Breast D001943:Breast Neoplasms D004724:Endoscopy D005260:Female D018226:Fibroadenoma D005500:Follow-Up Studies D006801:Humans D006984:Hypertrophy D059032:Learning Curve D008875:Middle Aged D009367:Neoplasm Staging D000071066:Patient Reported Outcome Measures D017060:Patient Satisfaction D011379:Prognosis D012189:Retrospective Studies D055815:Young Adult
Endoscopy-assisted breast surgery (EABS) Benign breast lesions Minimally invasive breast surgery