［Abstract］　Objective　To assess the clinical efficacy of unilateral endoscopic breast reconstruction/breast augmentation with prosthesis combined with contralateral endoscopic/open breast reconstruction of the latissimus dorsi muscle±prosthesis in breast cancer patients. Methods　The clinical data of 32 breasts in 16 breast cancer patients undergoing unilateral endoscopic breast reconstruction/breast augmentation with prosthesis combined with contralateral endoscopic/open breast reconstruction of the latissimus dorsi muscle±prosthesis from January 2021 to May 2024 in West China Hospital of Sichuan University were prospectively analyzed to assess the clinical efficacy of this surgical method. Results　The median follow-up time was 10.50 months, and the incidence of surgery-related complications was 18.75%(6/32), and the incidence of cosmetic surgery-related complications was 15.63%(5/32). Harris scale scoring was performed on the patients, and 81.25%(13/16) of the patients obtained excellent Harris scale scores and good Harris scale scores. Ueda scoring was performed on the patients, and 87.50%(14/16) of the patients obtained excellent Ueda scores and good Ueda scores. The SCAR-Q appearance scale scores of the patients were (56.56±20.77)points. Distant metastasis occurred in 1 patient after surgery, and local and regional recurrence occurred in 1 patient, and no deaths occurred. Conclusion　The surgical method of unilateral endoscopic breast reconstruction/breast augmentation with prosthesis combined with contralateral endoscopic/open breast reconstruction of the latissimus dorsi muscle±prosthesis has the advantages of favorable breast aesthetics and short operation time, which is worthy of clinical popularization and application.]]> 2024/10/30 0:00:00 1,2, ZHU Zhongjian^1,2, LIANG Faqing^1,2, XIE Yanyan^1,2, ZHONG Jiayuan^1,2, ZHANG Qing^1,2, LI Tianyuan^1,2, DU Zhenggui^1,2]]> DAI Hui^1,2, ZHU Zhongjian^1,2, LIANG Faqing^1,2, XIE Yanyan^1,2, ZHONG Jiayuan^1,2, ZHANG Qing^1,2, LI Tianyuan^1,2, DU Zhenggui^1,2 6true ［Abstract］　Objective　To explore the application effect of gland resection with modified axillary incision under endoscope in gynecomastia surgery. Methods　The clinical data of 48 patients with gynecomastia who underwent male mastectomy by using axillary approach under non-lipolytic endoscope in Department of Breast Surgery, Zhejiang Provincial People′s Hospital(People′s Hospital of Hangzhou Medical College) from August 2021 to July 2024 were retrospectively analyzed. The duration of operation, the incidence of postoperative complications and patients′ satisfaction level after operation were statistically analyzed. Results　All the patients were operated under endoscope, and no conversion to open surgery occurred in the patients. The median operative duration was 150(90-315)minutes. The final pathological examination results of all the patients showed glandular hyperplasia, and no malignant breast tumors were found. Unilateral subcutaneous seroma occurred in 3 cases and unilateral postoperative hemorrhage occurred in 1 case. No chest skin damage, wound dehiscence, infection and nipple necrosis were observed. Postoperative satisfaction scores were 1-3 points in 3 cases and 4-5 points in 45 cases, with a satisfaction rate of 93.75%. Conclusion　Gland resection with modified axillary incision under endoscope can shorten the operative duration and ensure the operation quality without increasing the occurrence of complications, and achieve good satisfaction of the patients.]]> 2024/10/30 20:36:43 MOU Jiancheng, TANG Hongchao, LI Yongfeng 5true ［Abstract］　Objective　To evaluate the clinical application effect of indocyanine green(ICG), blue dye and dual-tracer method in sentinel lymph node biopsy(SLNB) under fluorescence endoscope for breast cancer. Methods　The clinical data of 166 patients with breast cancer who underwent SLNB under fluorescence endoscope by using ICG combined with blue dye dual-tracer method in Department of Breast Surgery, General Surgery Center, Zhujiang Hospital of Southern Medical University from April 2021 to August 2022 were retrospectively analyzed. The development of sentinel lymph node(SLN) and the development of metastatic SLN were compared in endoscopic fluorescence mode, high-definition white light mode, and fluorescence+white light dual-tracer mode. The detectable rates and the detectable number of SLN and metastatic SLN in the three modes were compared, and the tracer performance under endoscope in the three methods were analyzed. Results　A total of 610 pieces of SLN were detected in the 166 patients, of whom 48 patients were detected with SLN metastasis, and endoscopic axillary lymph node dissection was performed on them, and a total of 95 pieces of metastatic SLN were detected. The detectable rate of SLN in the dual-tracer method group(98.19%) was significantly higher than that in the blue dye group(82.53%)(P<0.05), but there was no significant difference in the detectable rate of SLN between the dual-tracer method group(98.19%) and the ICG group(94.58%)(P>0.05). The number of SLN detected in the dual-tracer method group［(3.52±1.72)pieces］ was significantly higher than that detected in the blue dye group［(1.95±1.68)pieces］(P<0.05), but there was no significant difference in the number of SLN detected between the dual-tracer method group［(3.52±1.72)pieces］ and the ICG group［(3.36±1.82)pieces］(P>0.05). Conclusion　The use of ICG combined with blue dye dual-tracer method in SLNB under fluorescence endoscope has higher detectable rate of SLN and more numbers of lymph nodes detected.]]> 2024/10/30 0:00:00 1, XU Xirui², LUO Yunfeng¹, HE Linyun¹, ZHU Yanwen¹, LIAO Yue¹, ZHANG Pusheng¹]]> ZHU Di¹, XU Xirui², LUO Yunfeng¹, HE Linyun¹, ZHU Yanwen¹, LIAO Yue¹, ZHANG Pusheng¹ 4true ［Abstract］　Objective　To explore the clinical application value of contrast-enhanced ultrasound combined with intraoperative navigation with methylene blue in precision endoscopic sentinel lymph node biopsy of early breast cancer. Methods　A total of 100 patients with early breast cancer who were admitted to Department of Breast Surgery, the People′s Hospital of Guangxi Zhuang Autonomous Region from July 2022 to June 2024 were recruited. The patients were randomly divided into research group(undergoing contrast-enhanced ultrasound combined with intraoperative navigation with methylene blue) and control group(undergoing intraoperative navigation with methylene blue only), with 50 cases in each group. The operation time and detectable rate of sentinel lymph nodes were compared between the two groups. The sensitivity rate, specificity rate and accuracy rate of the diagnosis of contrast-enhanced ultrasound were calculated by using the results of histopathological examination as the gold standard. In the research group, the consistency of contrast-enhanced ultrasound and pathological biopsy in determination of the nature of sentinel lymph nodes was analyzed. Results　The detectable rates of sentinel lymph nodes in the research group and the control group were 100.00% and 84.00%, respectively, and the difference was statistically significant between the two groups(χ²=6.658, P=0.010). The operation time of sentinel lymph node biopsy in the research group was shorter than that in the control group, and the difference was statistically significant［(18.11±3.40)min vs (25.10±2.31)min; t=12.016, P<0.001］. The sensitivity rate, specificity rate and accuracy rate of the diagnosis of contrast-enhanced ultrasound were 78.57%, 88.89% and 86.00%, respectively. The results of Kappa consistency test showed that contrast-enhanced ultrasound and pathological biopsy were highly consistent in determining the nature of sentinel lymph nodes(Kappa=0.660, P<0.001). Conclusion　Contrast-enhanced ultrasound combined with intraoperative navigation with methylene blue is highly consistent with pathological biopsy in determining the nature of sentinel lymph nodes in precision endoscopic sentinel lymph node biopsy of early breast cancer, and the combined method has high detectable rate and short operation time, which is helpful for improving the level of clinical diagnosis and treatment, and has good practicability and pospects.]]> 2024/10/30 20:36:43 1, WEI Wensong¹, PAN Yinhua¹, HU Qiao², LI Lihui¹, WANG Bin¹, HE Liusheng¹, CHEN Xiaoyi¹, ZOU Quanqing¹]]> ZHAO Yingzhu¹, WEI Wensong¹, PAN Yinhua¹, HU Qiao², LI Lihui¹, WANG Bin¹, HE Liusheng¹, CHEN Xiaoyi¹, ZOU Quanqing¹ 3true ［Abstract］　Objective　To explore the application skills of non-lipolytic total endoscopic axillary lymph node and breast subcutaneous gland resection surgery. Methods　The clinical data of 59 female patients with breast cancer who were admitted to Department of Thyroid Breast and Vessel Surgery, Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine and received non-lipolytic total endoscopic axillary lymph node and breast subcutaneous gland resection surgery from July 2022 to December 2023 were summarized. Among the 59 patients, 11 patients underwent endoscopic axillary lymph node dissection due to sentinel lymph node positive. The obtained number of axillary lymph nodes, surgical time, nipple skin condition, upper limb sensory abnormalities, and motor dysfunction were evaluated. Results　The non-lipolytic endoscopic sentinel lymph node biopsy and breast subcutaneous gland resection surgery were successfully completed in all the patients. Two to eight pieces of sentinel lymph nodes were obtained in each case, with an average of 4.2 pieces in each case and a total of 210 pieces in all the 59 cases. Endoscopic axillary lymph node dissection was performed in 11 cases. Two patients had slight papillae scab after surgery, which shed 1 month later, and no nipple damage was observed. Six patients had mild subcutaneous effusion, which improved after massage to drive away the effusion, and no paresthesia or motor dysfunction occurred on the affected upper limbs. The patients were followed up for 8 to 15 months and the average was 10.3 months without local recurrence and distant metastasis. Conclusion　Non-lipolytic total endoscopic axillary lymph node and breast subcutaneous gland resection surgery is a smooth operation, simple and easy to learn, with fewer complications. It is a necessary operation for immediate breast reconstruction, and also provides one more option for personalized surgical treatment.]]> 2024/10/30 20:36:43 1, LUO Yunfeng¹, ZHU Yanwen², ZHU Di², LI Mengyun¹]]> HUANG Yu¹, LUO Yunfeng¹, ZHU Yanwen², ZHU Di², LI Mengyun¹ 2true ［Abstract］　Objective　To summarize and consider the coordination skills of the camera-holder assistant in endoscopic axillary sentinel lymph node biopsy and lymph node dissection, and to provide theoretical and technical support for the smooth implementation in endoscopic axillary sentinel lymph node biopsy and lymph node dissection. Methods　The clinical data of 154 patients undergoing endoscopic axillary surgery in Department of Breast Surgery, General Surgery Center, Zhujiang Hospital of Southern Medical University from July 2022 to June 2023 were analyzed. Among the 154 patients, 96 patients underwent endoscopic axillary sentinel lymph node biopsy and 58 patients underwent endoscopic axillary lymph node dissection. Before the surgery, clarity of the lens was adjusted to the best and fluorescent sentinel lymph node localization was performed by the camera-holder assistant. During the operation, sentinel lymph nodes and lymphatic vessels connected to the sentinel lymph nodes were clearly exposed, and the intercostal brachial nerve and axillary vein were kept at visual field level in the patients undergoing axillary lymph node dissection, and the lens were moved with the ultrasonic knife to avoid accidental injury. Results　All the 154 patients were completed surgery under endoscope, and no patients were transferred to open surgery. The endoscopic operation time for axillary sentinel lymph node biopsy was 10-46(21.02±7.03)minutes, and the endoscopic operation time for axillary lymph node dissection was 30-85(59.90±14.23)minutes. No obvious bleeding was observed during the operation under endoscope. The lens of the endoscope were cleaned 3-12(5.21±2.52)times. Conclusion　The successful process of endoscopic breast surgery requires the tacit cooperation between the surgeon and the camera-holder assistant, and an excellent camera-holder assistant not only needs to be familiar with the basic knowledge of anatomical structure of the mammary glands and axilla, and the surgical procedure, but also needs to master the collaboration skills of holding camera in order to assist the surgeon effectively and ensure the safety and high efficiency of the surgical process.]]> 2024/10/30 20:36:43 ZHU Yanwen, ZHANG Pusheng, HUANG Hongyan, LUO Yunfeng 1true