Single-Port Insufflation Technique for Endoscopic Nipple-Sparing Mastectomy: Initial Experience and Learning Curve.
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Background In recent years, breast surgery has undergone considerable development in the field of minimally invasive techniques such as endoscopic (E-NSM) or robotic (R-NSM) nipple sparing mastectomy. However, access to robotic platforms is not always possible. In this study, we present our initial experience with E-NSM through a single port and insufflation with immediate reconstruction (SPIE-NSM + IBR) as a surgical option for minimally invasive mastectomy. Methods The medical records of patients who underwent SPIE-NSM + IBR from February 2024 to February 2025, performed by the same surgeon at a single institution, were collected and analysed for feasibility, safety and reproducibility by evaluating the conversion rate to open surgery, the learning curve with operating times and the cumulative sum (CUSUM) plot method, and the number of complications. Results 23 SPIE-NSM + IBR were performed on 22 women. The times for SPIE-NSM and SPIE-NSM + IBR decreased with accumulated case experience, and according to Cusum's analysis, the improvement started from the 11th case in all two scenarios. The mean operative times for the final cases (12th-23rd) decreased to 105 ± 33.1 minutes in SPIE-NSM (p = 0.009), 118.7 ± 39.7 minutes in SPIE-NSM plus axilla (p = 0.002) and 167.6 ± 34 minutes in SPIE-NSM + IBR (p = 0.003), compared to the group of initial cases. There were no cases requiring open surgery (0%). The median hospital stay was 1(1–2) day. There was one serious complication (IIIa, 4.35%). No positive margins were found in the final pathological examination, nor were there any implant losses or recurrences during follow-up of 4.3 months. Conclusions Our study confirms that SPIE-NSM + IBR is a feasible and safe alternative to R-NSM-IBR. It is a technique available in all hospitals, as it uses laparoscopic instruments that allow more patients to benefit from minimally invasive mastectomy. An acceptable learning curve is necessary.
