Single-Port Three-Dimensional Endoscopic-Assisted Axillary Lymph Node Dissection (S-P 3D E-ALND): Surgical Technique and Preliminary Results

Abstract

Background: Endoscopic-assisted breast surgery (EABS) provides better cosmetic outcomes for breast cancer patients with small incisions in an inconspicuous area. However, an extended incision and heavy assistant retraction are usually required for an adequate exposure for conventional axillary lymph node dissection (ALND). Therefore, we propose an innovative single-port three-dimensional endoscopic-assisted ALND (S-P 3D E-ALND) to facilitate better visualization, and report its preliminary outcomes herein.

Methods: The surgical technique of the S-P 3D E-ALND, using either monopolar Endo Hook, LigaSure, or Sonicision, is described. A total of 11 breast cancer patients who received the S-P 3D E-ALND in a single institution from January 2023 to September 2023 were enrolled. The preliminary results of the S-P 3D E-ALND, including perioperative parameters, complication, and short-term oncological outcomes, were retrospectively analyzed.

Results: Endoscopic breast and axillary procedures were conducted via a single axillary incision. The primary success rate of the S-P 3D E-ALND was 100% without a conversion to open surgery. The median operative time for the S-P 3D E-ALND was 39 (IQR = 28, 49) minutes. Average blood loss during E-ALND was 3 (IQR = 3, 5) mL. The median number of harvested LN was 10 (IQR = 8, 11) LNs. During the median follow-up time of 7 months, there was no complication, lymphedema, shoulder stiffness, or chronic arm numbness found. None of the patients reported locoregional recurrence, distant metastasis, or mortality.

Conclusion: The S-P 3D E-ALND can serve as an alternative approach for ALND in breast cancer patients undergoing EABS, as our findings indicate it results in only minor complications.