BACKGROUND: The use of the flexible endoscope as a surgical platform potentially exposes a range of new surgical approaches and benefits yet to be fully defined. A new method using the flexible endoscope to undertake axillary dissection for breast cancer treatment is explored together with an investigation into its acceptability to the general public. METHODS: Endoscopic axillary dissection via a transumbilical approach using the flexible endoscope passed subcutaneously from the umbilicus is described for four human cadaveric axillas. A questionnaire, validated by clinicians, explored the general public's reaction to the approach and how it might be influenced by potentially serious morbidity such as an increased rate of cancer recurrence. RESULTS: All axillas were accessed successfully via the transumbilical approach. Levels 1 and 2 axillary dissection was attempted on four axillas. Scarring from previous axillary surgery prevented dissection in one case. In the remaining three cases, respectively 12, 11, and 14 lymph nodes were harvested. The operative times improved with each case, from 1080 to 390 min. A total of 127 people responded to the questionnaire, with 73 % preferring the described approach over the open and periareolar alternatives when morbidities were considered equivalent. When a hypothetical elevated risk of cancer recurrence was included with the transumbilical approach, one-fifth of the public still accepted the approach due to the likelihood of a superior cosmesis. CONCLUSION: The use of the flexible endoscope for oncologically safe levels 1 and 2 axillary dissection is possible and would be acceptable to the general public if it were clinically approved. However, significant challenges with the current endoscopic equipment and relevant instrumentation limit the potential of the technique. Technical innovation in terms of new instrument design with improved ergonomics will reduce long operating times and fatigue, thus ensuring surgical acceptance of the flexible endoscope.
BACKGROUND: The use of the flexible endoscope as a surgical platform potentially exposes a range of new surgical approaches and benefits yet to be fully defined. A new method using the flexible endoscope to undertake axillary dissection for breast cancer treatment is explored together with an investigation into its acceptability to the general public. METHODS: Endoscopic axillary dissection via a transumbilical approach using the flexible endoscope passed subcutaneously from the umbilicus is described for four human cadaveric axillas. A questionnaire, validated by clinicians, explored the general public's reaction to the approach and how it might be influenced by potentially serious morbidity such as an increased rate of cancer recurrence. RESULTS: All axillas were accessed successfully via the transumbilical approach. Levels 1 and 2 axillary dissection was attempted on four axillas. Scarring from previous axillary surgery prevented dissection in one case. In the remaining three cases, respectively 12, 11, and 14 lymph nodes were harvested. The operative times improved with each case, from 1080 to 390 min. A total of 127 people responded to the questionnaire, with 73 % preferring the described approach over the open and periareolar alternatives when morbidities were considered equivalent. When a hypothetical elevated risk of cancer recurrence was included with the transumbilical approach, one-fifth of the public still accepted the approach due to the likelihood of a superior cosmesis. CONCLUSION: The use of the flexible endoscope for oncologically safe levels 1 and 2 axillary dissection is possible and would be acceptable to the general public if it were clinically approved. However, significant challenges with the current endoscopic equipment and relevant instrumentation limit the potential of the technique. Technical innovation in terms of new instrument design with improved ergonomics will reduce long operating times and fatigue, thus ensuring surgical acceptance of the flexible endoscope.
Authors: Elias Karakas; Thorsten Steinfeldt; Andreas Gockel; Thorsten Schlosshauer; Carsten Dietz; Jens Jäger; Reiner Westermann; Frank Sommer; Hans Rudolf Richard; Cornelia Exner; Andreas M Sesterhenn; Detlef K Bartsch Journal: Surgery Date: 2011-03-31 Impact factor: 3.982
Authors: Wendy W T Lam; Wylie W Y Li; George A Bonanno; Anthony D Mancini; Miranda Chan; Amy Or; Richard Fielding Journal: Breast Cancer Res Treat Date: 2011-10-05 Impact factor: 4.872
Authors: Armando E Giuliano; Kelly K Hunt; Karla V Ballman; Peter D Beitsch; Pat W Whitworth; Peter W Blumencranz; A Marilyn Leitch; Sukamal Saha; Linda M McCall; Monica Morrow Journal: JAMA Date: 2011-02-09 Impact factor: 56.272
Authors: James Clark; David P Noonan; Valentina Vitiello; Mikael H Sodergren; Jianzhong Shang; Christopher J Payne; Thomas P Cundy; Guang-Zhong Yang; Ara Darzi Journal: Surg Endosc Date: 2014-08-09 Impact factor: 4.584