title: Endoscopy-assisted surgery for the management of benign breast tumors: technique, learning curve, and patient-reported outcome from preliminary 323 procedures.
abstract: BACKGROUND
  Endoscopy-assisted breast surgery (EABS), a technique that optimizes cosmetic outcome because it is performed through small wounds hidden in inconspicuous areas, could be an alternative surgical technique for benign breast tumors. In this study, we report the preliminary results of 323 EABS procedures performed at our institution for the management of benign breast tumors.
  
  
  METHODS
  The medical records of patients who underwent EABS for benign breast lesions during the periods August 2010 to December 2015 were collected from the Changhua Christian Hospital EABS database. Data on clinicopathologic characteristics, type of surgery, hospital stay, and complications were analyzed to determine the effectiveness of the procedure for benign breast tumors. The operating time with the number of procedure performed was analyzed for learning curve evaluation. Patient satisfaction with cosmetic outcome was evaluated with a self-report questionnaire.
  
  
  RESULTS
  A total of 323 EABS procedures were performed in 286 patients with benign breast lesions, including 249 (90.5%) patients with unilateral lesions. The mean age was 36 years, the mean tumor size was 2.2 cm, and the mean distance from the nipple to the tumor was 5.2 cm. Most (93.8%, 303/323) of these tumors were excised through a transareolar wound, 2.4% (8/323) through an axillary wound, and 0.3% (1/323) through the infra-mammary fold. Histopathologic analysis revealed that 63.5% (202/318) of the tumors were fibroadenoma-related lesions. The mean operative time was 81.4 min (59~89 min), which was decreased with experience increased. The overall rate of complications was 6.5%, and all were minor and wound-related. Among the 110 patients who participated in the self-report cosmetic outcome evaluation, 85.4% reported being satisfied with the cosmetic result, and almost all were satisfied with breast symmetry. Of the patients interviewed, 92.7% reported that they would choose the same procedure if they had to undergo the operation again.
  
  
  CONCLUSIONS
  Our preliminary results show that transareolar video-assisted breast surgery is a safe and effective procedure with good cosmetic outcome and that it could be appropriate for patients with moderate to large peripherally located breast tumors.
  
  
  BACKGROUND
  CCH-IRB No.15115. Registered 14 December 2015 (retrospectively registered).
authors.affiliation: Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. hwlai650420@yahoo.com.tw.|Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan. hwlai650420@yahoo.com.tw.|Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan. hwlai650420@yahoo.com.tw.|School of Medicine, National Yang Ming University, Taipei, Taiwan. hwlai650420@yahoo.com.tw.
authors.forename: Hung-Wen
authors.identifier: http://orcid.org/0000-0003-0197-6075
authors.initials: HW
authors.lastname: Lai
authors.affiliation: Division of Breast surgery and General Surgery, Department of Surgery, Cardinal Tien Hospital, Xindian Dist., New Taipei City, Taiwan.
authors.forename: Hui-Yu
authors.initials: HY
authors.lastname: Lin
authors.affiliation: Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.|Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.|Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.|Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Shou-Tung
authors.initials: ST
authors.lastname: Chen
authors.affiliation: Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.|Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.|Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Dar-Ren
authors.initials: DR
authors.lastname: Chen
authors.affiliation: Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.|Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.|Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Shou-Jen
authors.initials: SJ
authors.lastname: Kuo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001940:Breast / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000145:classification / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D018226:Fibroadenoma / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy / Q000473:pathology / Q000601:surgery*; D059032:Learning Curve; D008875:Middle Aged; D009367:Neoplasm Staging; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
keywords: Benign breast lesions; Endoscopy-assisted breast surgery (EABS); Minimally invasive breast surgery