关键词: 单孔腔镜, 胸外侧入路, 腋窝入路, 扶镜技巧

Abstract: To compare the camera assistance effect and learning curve of single-port endoscopic subcutaneous mastectomy through the lateral chest wall approach and axillary approach. Methods    Develop a scene-guided camera assisted endoscopic breast subcutaneous resection procedure for lateral chest wall and axillary approach, and conduct a retrospective analysis of the clinical data from 75 patients who underwent this procedure at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2022 and August 2024. The patients were categorized into two groups based on their surgical approach: the lateral chest wall group (30 cases) and the axillary approach group (45 cases). A comparison was conducted between the two groups in terms of operation time, intraoperative blood loss, camera assistance evaluation, and learning curve. Results    The surgeries of 75 patients were all completed under single-port endoscopic surgery without conversion to open surgery. The surgical time for the lateral chest wall approach group was significantly shorter than that of the axillary approach group ［(83.97±10.02) min vs. (89.69±11.75) min, P=0.027］, while there were no statistically significant differences in intraoperative blood loss, postoperative hospital stay, and postoperative complications (P>0.05). The structured assessment of laparoscopic assistant skills (SALAS) scores showed that the verbal command item score for the lateral chest wall approach group was higher than that of the axillary approach group, with a statistically significant difference ［(4.27±0.89) points vs. (3.58±1.45) points, P=0.026］. However, there were no statistically significant differences in centering the operating field of view, maintaining a horizontal alignment between the field of view and the operating area, and visualization of instruments between the two groups as well as in adjusting the camera position by the surgeon and SALAS total score (P>0.05). The lateral chest wall approach group and the axillary approach group of assisting surgeons reached a learning turning point in the 10th and 15th surgeries, respectively. Conclusion    The application of the scene-guided camera assistance in the scenarios of lateral chest wall and axillary approaches to endoscopic breast subcutaneous resection streamlines the process, with the lateral chest wall approach being beneficial in reducing surgical time and decreasing the learning curve for assisting surgeons.

Key words: single-port endoscope, lateral chest wall approach, axillary approach, camera-assisted technique