Da Vinci robot-assisted filling with pedicled omental flap for breast reconstruction / 局解手术学杂志

Objective To explore the effect of pedicled omental flap with Da Vinci surgical system for breast reconstruction,so as to facilitate the application of robot-assisted surgery in the breast reconstruction after breast cancer(BC) surgery.Methods A luminal BC patient,administrated in March 2017,received Da Vinci robot-assisted filling with pedicled omental flap after extensive lumpectomy and sentinel lymph node biopsy.Blood supply,wound healing,cosmetic outcome,complications and satisfaction of the patient were evaluated.Results The wound healed well,with no obvious scar.The reconstructed breast had desirable volume and looked symmetrical against the other side.The cosmetic outcome was excellent and the patient was satisfied with the surgery.No recurrence or metastasis was found during the twomonth post-operational follow-up.Conclusion Da Vinci robot-assisted breast reconstruction with pedicled omental flap has the advantages of clear vision,precise movement and flexible machinery joint.Breast conservation and autologous reconstruction with this technique substantially improves the psychological and social well-being of the patient.

Present and future of robot-assisted endoscopic thyroid surgery / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>Robot-assisted endoscopic surgery has been increasingly accepted because of its unique three-dimensional vision and precise simulation-based technology. However, the utilization of robotic systems in thyroid surgery is limited. We conducted a systematic review to assess the application and development of robot-assisted endoscopic surgical technique in thyroid surgery.</p><p><b>DATA SOURCES</b>Articles published in PubMed before June, 2011 about robot-assisted endoscopic surgery were selected.</p><p><b>STUDY SELECTION</b>Original articles and critical reviews selected were related to robot-assisted (thyroid) surgery or endoscopic thyroid surgery, and a total of 3540 relevant articles were retrieved and 34 were finally cited.</p><p><b>RESULTS</b>Robot-assisted operation of benign thyroid diseases were successfully performed, although the operation time is too long to exhibit its advantages. Nevertheless, the superiority of robot-assisted endoscopic surgical technique compared to conventional endoscopic surgery in the treatment of thyroid carcinoma were obvious, since robotic radical thyroidectomy with central and lateral neck lymph node dissection could be achieved while maintaining operative results and cosmetic outcomes equivalent to or better than conventional endoscopic surgery. Furthermore, the learning curve duration of robot-assisted endoscopic thyroid surgery was shorter than that of conventional endoscopy, especially for the novices without any endoscopic surgical basis.</p><p><b>CONCLUSION</b>Robot-assisted endoscopic thyroid surgery, with its safety, feasibility, thoroughness, cosmetic benefits, and ability to overcome the limitations of conventional endoscopic surgery, will be further improved and applied, and is worthy of attention.</p>

A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Breast conserving surgery (BCS) has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy (ESM) plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting.</p><p><b>METHODS</b>From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups (P > 0.05). The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM (88.4%, 38/43) and BCS (92.6%, 50/54) patients (P > 0.05). During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence -one of these patients died of multiple organ metastasis.</p><p><b>CONCLUSIONS</b>After considering the wide indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants - the new surgery of choice for breast cancer - warrants serious consideration as the prospective next standard surgical procedure.</p>

Contribution of minute axillary lymph nodes to accurate staging for patients with breast cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Axillary lymph node metastasis is a very important metastatic pathway in breast cancer and its accurate detection is important for staging tumour and guiding therapy. However, neither the accuracy of routine detection of lymph node in surgical specimens nor the significance of minute lymph node with metastases in breast cancer is clear. A modified method for conveniently detecting minute lymph node in specimens of axillary dissections in patients with breast cancer was used to analyze their influence on staging breast cancer.</p><p><b>METHODS</b>Lymph nodes in fresh, unfixed, specimens of axillary dissections from 127 cases of breast cancer were detected routinely. Then the axillary fatty tissues were cut into 1 cm thick pieces, soaked in Carnoy's solution for 6 to 12 hours, taken out and put on a glass plate. Minute lymph nodes were detected by light of bottom lamp and examined by routine pathology.</p><p><b>RESULTS</b>Lymph nodes (n = 2483, 19.6 +/- 8.0 per case) were found by routine method. A further 879 lymph nodes up to 6 mm (781 < 3 mm, 6.9 +/- 5.3 per case, increasing mean to 26.5 +/- 9.7) were found from the axillary tissues after soaking in Carnoy's solution. By detection of minute lymph nodes, the stages of lymph node metastasis in 7 cases were changed from pathological node (pN) stage pN(0) to pN(1) in 4 cases, from pN(1) to pN(2) in 2 and from pN(2) to pN(3) in 1.</p><p><b>CONCLUSIONS</b>The accurate staging of axillary lymph node metastasis can be obtained routinely with number of axillary lymph nodes in most cases of breast cancer. To avoid neglecting minute lymph nodes with metastases, small axillary nodes should be searched carefully in the cases of earlier breast cancer with no swollen axillary nodes. Treatment with Carnoy's solution can expediently detect minute axillary nodes and improve the accurate staging of lymph nodes in breast cancer.</p>

Technique investigation of endoscopic axillary lymph node dissection by liposuction / 中华外科杂志

<p><b>OBJECTIVE</b>To study the technique of endoscopic axillary lymph node dissection by liposuction.</p><p><b>METHODS</b>Endoscopic axillary lymph node dissection (E-ALND) after liposuction (group A) were performed on 45 patients with breast cancer from Dec. 2004 to Oct. 2005. It was compared with traditional ALND (group B).</p><p><b>RESULTS</b>The average operation time of E-ALND was 108 min (60 - 190 min), it was longer than that in group B (P < 0.05). The total blood loss in group A was 152.82 ml (80 - 220 ml), it was less than that in group B significantly (P < 0.01). In group A, the mean lymph nodes harvested by endoscopy were 18 (8 - 34), the total postoperative lymph flow was 140.38 ml (60 - 180 ml), the duration of drainage was 6.91 d (6 - 15 d). The postoperation complication included axillary seromas 7 cases, epidermic blister 5 cases, operation area phlegmon 2 cases were found in group A. There was no significant difference between two groups in the total postoperative lymph flow, the duration of drainage and the number of dissected lymph nodes and postoperation complication. The incision of chest wall was smaller in group A, and patients by this surgery were satisfied with the cosmetic results.</p><p><b>CONCLUSIONS</b>Endoscopic axillary lymph node dissection by liposuction could match the traditional lymphadenectomy. The technique should be further standardized.</p>