Surgical treatment of breast cancer is becoming increasingly precise, less invasive, and more cosmetically pleasing. Sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) remain the standard treatment methods for breast cancer. However, these methods still require incisions in the breasts or axilla. Mastoscopic axillary lymph node dissection (MALND) surgery, although first reported several years ago, has not been widely used as it involves lipolysis. Non-lipolytic mastoscopy may be more appealing; however, the lack of a cavity in the breast and the abundant fat and glands make this procedure challenging. In addition, incision of the trocar in the axilla has been shown to have no advantage over traditional breast-conserving surgery. The present study describes 16 cases of non-lipolytic endoscopic axillary surgery without incisions in the axilla.

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Background. Sentinel lymph node biopsy (SLNB) has been an alternative to axillary lymph node dissection as a standard procedure for breast cancer patients with clinically negative lymph nodes. Endoscopic technique has been developed for over 20 years but remains to be mastered by a slice of surgeons. Suction and squeezing in the liposuction endoscopic procedures may increase risk of local recurrence and metastasis. In this study, we present our method of SLNB procedure through the periareolar incision which improves the shape of the breast-conserving surgery. Patients and Procedures. Twenty-eight breast cancer patients with clinically negative lymph nodes received this procedure. Methylene blue dye and technetium-99m sulfur colloid were used to be the tracker of sentinel lymph nodes (SLNs). Periareolar incision was the main surgical technique. The STORZ HD endoscopic system and some special instruments were used during the operation. Results. SLNs can be accurately located and biopsied under an endoscope without additional incisions. The SLNs detection rate, sensitivity, and false-negative rate are 88%, 80%, and 11.1%, respectively. And, the complications such as paresthesia and upper limb lymphedema are similar compared with traditional breast-conserving surgery (10.7% vs 9.8% and 7.1% vs 7.8%). Conclusion. Endoscopic technique can be used to accurately assess the status of SLNs in patients with breast cancer. Nonliposuction endoscopic breast-conserving surgery is one of the safe and alternative surgical procedures for early breast cancer.