Initial operative experience of single‐port retroperitoneal laparoscopic nephrectomy

This paper reports our early experience with single‐port laparoscopic nephrectomy via the retroperitoneal approach. Since April 2010, 23 patients have undergone single‐port laparoscopic surgery for simple nephrectomy (n = 11 patients) and radical nephrectomy (n = 12) by an experienced laparoscopic surgeon. The mean operative time was 265.2 min and the mean estimated blood loss was 96.7 mL. The procedure was completed in all patients without conversion to standard laparoscopy or open surgery. No intraoperative or acute postoperative complications occurred. When the single‐port retroperitoneal laparoscopic nephrectomy group was retrospectively compared with the group that had undergone standard retroperitoneal laparoscopic nephrectomy, no significant difference was noted with respect to age, body mass index, operation time, time to eat, catheter removal or length of hospitalization (P > 0.05). A significant difference in favor of the single‐port retroperitoneal laparoscopic nephrectomy group was noted with respect to the estimated blood loss (P = 0.027) and the visual analog pain scale score at discharge (P = 0.016). Although our findings show that retroperitoneal single‐port laparoscopic nephrectomy is feasible with advanced techniques and optimal instrumentation, further study is required to determine the future extent of its clinical application.     

Real‐time electromagnetic navigation for breast‐conserving surgery using NaviKnife technology: A matched case‐control study

Breast‐conserving surgery (BCS) is a mainstay in breast cancer treatment. For nonpalpable breast cancers, current strategies have limited accuracy, contributing to high positive margin rates. We developed NaviKnife, a surgical navigation system based on real‐time electromagnetic (EM) tracking. The goal of this study was to confirm the feasibility of intraoperative EM navigation in patients with nonpalpable breast cancer and to assess the potential value of surgical navigation. We recruited 40 patients with ultrasound visible, single, nonpalpable lesions, undergoing BCS. Feasibility was assessed by equipment functionality and sterility, acceptable duration of the operation, and surgeon feedback. Secondary outcomes included specimen volume, positive margin rate, and reoperation outcomes. Study patients were compared to a control group by a matched case‐control analysis. There was no equipment failure or breach of sterility. The median operative time was 66 (44‐119) minutes with NaviKnife vs 65 (34‐158) minutes for the control (P = .64). NaviKnife contouring time was 3.2 (1.6‐9) minutes. Surgeons rated navigation as easy to setup, easy to use, and useful in guiding nonpalpable tumor excision. The mean specimen volume was 95.4 ± 73.5 cm³ with NaviKnife and 140.7 ± 100.3 cm³ for the control (P = .01). The positive margin rate was 22.5% with NaviKnife and 28.7% for the control (P = .52). The re‐excision specimen contained residual disease in 14.3% for NaviKnife and 50% for the control (P = .28). Our results demonstrate that real‐time EM navigation is feasible in the operating room for BCS. Excisions performed with navigation result in the removal of less breast tissue without compromising postive margin rates.     

Utilization of BioZorb implantable device in breast‐conserving surgery

BioZorb fiducial marker is an implantable device made of six clips to mark the surgical site of tissue removal in three dimensions. The marker facilitates focused radiation therapy, while allowing for tissue ingrowth during the healing process with resorption by the body overtime. Current literature investigating the use of the BioZorb is limited and focused on its value for radiation treatment. Our objective was to investigate the feasibility and surgical complications associated with the BioZorb in breast‐conserving surgery. From April 2015 to June 2018, 89 patients who underwent 91 partial mastectomies with planned adjuvant radiation therapy and placement of the BioZorb. Demographics, type of BioZorb used, complication rate, and postoperative examinations were analyzed. A total of 89 patients who were a median age of 59 years (range 34‐84) underwent 91 operations with BioZorb placement—86.8% underwent a partial mastectomy (n = 79), and 13.2% underwent a breast wide re‐excision for margins at the time of BioZorb placement (n = 12). Of the 79 partial mastectomies, 21.5% (n = 17) were palpable tumors. Location of the tumor and subsequent BioZorb placement was most often in the upper outer quadrant (40.7%), followed by upper inner (27.5%), lower outer (20.9%), and lower inner quadrants (10.9%). 92.3% (n = 84) had a single BioZorb placed, 5.5% (n = 5) had two BioZorbs placed in a single lumpectomy cavity, and 2.2% (n = 2) had two BioZorbs placed in separate lumpectomy cavities of the same breast. Of the 10 different tissue marker sizes used, a 2 × 3 cm BioZorb was most commonly used (37/98, 37.8%), followed by 3 × 4 cm (25/98, 25.5%) and 1 × 3 × 2 (9/98, 9.2%). A total of five patients underwent immediate bilateral breast reduction following placement of the BioZorb. Of the 91 operations, 22 patients had a subsequent reoperation for positive margins after initial placement of the BioZorb, of which 86.4% retained the BioZorb . During these reoperations, only 1 patient had the BioZorb removed due to discomfort (4.5%) and two had it removed due to subsequent mastectomy (9.1%). At a median time of 1.1 years, the BioZorb continued to be palpable on clinical breast examination in 63.6% of patients. The longest time that the BioZorb continued to be palpable was 2.8 years. Additional imaging was ordered because a clinician palpated a mass, unaware it was the BioZorb 8.8% of the time (n = 8). Thirty‐day complications include 3.3% of patients with an infection requiring antibiotics (n = 3) and 2.2% with an abscess requiring aspiration and antibiotics without removal of the BioZorb. One patient had migration of the BioZorb from the breast to the axilla which resulted in surgical explant at 9 months post‐op. BioZorb is feasible to use in breast‐conserving surgery with few short‐ and long‐term complications, but will result in a palpable mass that may persist for more than 1 year. Explantation is rare.     

Evaluation of the central pedicled,modified Wise‐pattern technique as a standard level II oncoplastic breast‐conserving surgery: A retrospective clinicopathological study of 190 breast cancer patients

Involving 207 breast cancer patients a retrospective study was performed to facilitate the acceptance of the central pedicled, modified Wise‐pattern therapeutic mammoplasty technique as a standard volume‐displacement level II oncoplastic breast‐conserving surgery (OBCS). The overall local recurrence rate was 5.8% with an average follow‐up of 43.9 months. The median time to the initiation of the adjuvant treatment was 4.9 weeks. Due to positive surgical margins, 13 (6.84%) completional surgeries were performed. In total, 45 complications (12.9%) were recorded. The median values of the esthetic outcomes represented improved cosmetic results. The modified Wise‐pattern technique could be a standard, safe and repeatable level II volume‐displacement OBCS.     

早期乳腺癌36例行保乳手术治疗体会

目的 总结早期乳腺癌施行保留乳房的根治术的治疗效果。方法 分析2002年1月～2005年12月我科选择开展的保乳手术的36例乳腺癌Ⅰ、Ⅱa患者的近期治疗效果。结果 本组患者均行保留乳房的乳腺癌根治术，术后联合化疗、放疗、内分泌治疗均获得较满意的效果。结论 早期乳腺癌行保乳手术联合放、化疗可达到与传统根治手术相同的近期效果，并具有患者心理打击小、美容效果好的优点。     

Acute toxicities after proton beam therapy following breast‐conserving surgery for breast cancer: Multi‐institutional prospective PCG registry analysis

We investigated adverse events (AEs) and clinical outcomes for proton beam therapy (PBT) after breast‐conserving surgery (BCS) for breast cancer. From 2012 to 2016, 82 patients received PBT in the prospective multi‐institutional Proton Collaborative Group registry. AEs were recorded prospectively at each institution. Median follow‐up was 8.1 months. Median dose was 50.4 Gy in 28 fractions. Most patients received a lumpectomy bed boost (90%) and regional nodal irradiation (RNI)(83%). Six patients (7.3%) experienced grade 3 AEs (5 with dermatitis, 5 with breast pain). Body mass index (BMI) was associated with grade 3 dermatitis (P = .015). Fifty‐eight patients (70.7%) experienced grade ≥2 dermatitis. PBT including RNI after BCS is well‐tolerated. Elevated BMI is associated with grade 3 dermatitis.     

乳腺癌保乳手术切缘问题

尽管外科医生普遍认为保乳手术切缘应该是没有肿瘤细胞的干净切缘,而肿瘤残留将可能增加局部复发概率,甚至增加病死率;但是由于保乳手术在各个国家地区的做法不同及切缘评估方法的差异,至今无保乳手术中有关安全切缘宽度的共识或指南。保乳手术应该保证切缘无瘤,否则肿瘤的残留将使得一个根治性的手术人为转变成为姑息手术及活检手术;将随后的辅助治疗人为转变成为解救治疗。     

New three‐dimensional head‐mounted display system,TMDU‐S‐3D system,for minimally invasive surgery application: Procedures for gasless single‐port radical nephrectomy

We present an application of a new three‐dimensional head‐mounted display system that combines a high‐definition three‐dimensional organic electroluminescent head‐mounted display with a high‐definition three‐dimensional endoscope to minimally invasive surgery, using gasless single‐port radical nephrectomy procedures as a model. This system presents the surgeon with a higher quality of magnified three‐dimensional imagery in front of the eyes regardless of head position, and simultaneously allows direct vision by moving the angle of sight downward. It is also significantly less expensive than the current robotic surgery system. While carrying out gasless single‐port radical nephrectomy, the system provided the surgeon with excellent three‐dimensional imagery of the operative field, direct vision of the outside and inside of the patient, and depth perception and tactile feedback through the devices. All four nephrectomies were safely completed within the operative time, blood loss was within usual limits and there were no complications. The display was light enough to comfortably be worn for a long operative time. Our experiences show that the three‐dimensional head‐mounted display system might facilitate maneuverability and safety in minimally invasive procedures, without prohibitive cost, and thus might mitigate the drawbacks of other three‐dimensional vision systems. Because of the potential benefits that this system offers, it deserves further refinements of its role in various minimally invasive surgeries.     

乳腺癌保乳手术的体会

目的　总结和探讨乳腺癌保乳手术保持乳房良好外形 ,在术前、术中和术后应注意的问题。方法　 3 7例患者接受了乳腺癌保乳手术。术后从乳头外观、双乳头水平差距、双乳头距同侧腋前线垂直距离之差距和瘢痕对乳房外形影响等四个方面的量化标准 ,评估保留乳房的外形美观效果。四项指标积分≥ 2 1分为优 ,13～ 2 0分为良 ,<13分为差。结果　术后保留乳房外形优良者 3 0例 ( 81.1% ) ,乳房外形较差者 7例 ( 18.9% )。常见问题是因切口瘢痕致乳房变形、乳头歪斜、乳头不自然挺立 ,以及与对侧乳头水平高度差距明显。结论　术前认真设计手术切口、术中注意术区皮瓣和保留乳腺组织的彻底游离以及切除、缝合技巧 ,术后切口包扎时注意避免压迫乳头等 ,将有助于保持保留乳房的外形美观效果     

乳房整形技术在乳腺癌保乳手术中的应用效果分析

目的：探究分析在乳腺癌保乳手术当中,乳房整形手术的应用临床效果。方法：选自我院2010年～2012年收治的在保乳手术当中应用乳房整形手术的患者共50例,对其,I盘床资料进行回顾性分析,对患者术后美容效果进行调查。结果：全部患者均成功完成手术,术后对患者进行随访,随访时间为（6～12）个月,无患者出现局部或者区域淋巴结肿瘤复发迹象;患者手术后乳房美容效果优良率为92％（46／5O）。结论：乳腺癌患者可以通过乳房整形技术进行保乳治疗,该手术方法有着安全高效的优点,手术之后患者乳房外形以及整体美容整体满意程度较高,值得临床推广。     

Outcomes for case‐matched single‐port colectomy are comparable with conventional laparoscopic colectomy

Aim With the introduction of single‐port surgery, expected advantages are improved cosmesis, decrease of pain and shorter length of stay. The aim of this study was to compare early outcomes of single‐port colectomy with those of conventional laparoscopic colectomy. Method All consecutive patients undergoing single‐port colectomy between January and June 2010 were identified from a prospective database. They were matched for age, sex, body mass index, American Society of Anesthesiology score and type of resection with patients who had conventional laparoscopic colectomy. All perioperative data, analgesic requirement, pain scores and inflammatory response were compared using the Wilcoxon signed‐rank and McNemar tests. Results Fourteen patients [five men, nine women; median age (interquartile range) 56 (30–73) years, body mass index (interquartile range) 22 (20–24) kg/m²] underwent single‐port colectomy and were matched with patients who had conventional laparoscopic colectomy. Median operating times, estimated blood loss, pain scores, analgesic requirement, inflammatory response and length of hospital stay were similar. Median increase in incision length was significantly higher in the single‐port group (P = 0.004), but maximal incision length for specimen extraction was comparable. There were no anastomotic leaks, wound infections or 30‐day readmissions. Conclusion In a case‐matched setting with a small sample size, single‐port laparoscopic colectomy has comparable outcomes to conventional laparoscopic colectomy.