Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST). 2013 Feb;23(2):91-9.

Technical Feasibility and Cosmetic Advantage of Hybrid Endoscopy-Assisted Breast-Conserving Surgery for Breast Cancer Patients.

Shinji Ozaki, MD, PhD1, Masahiro Ohara, MD, PhD1, Hideo Shigematsu, MD, PhD1, Tatsunari Sasada, MD1, Akiko Emi, MD, PhD1, Norio Masumoto, MD, PhD1, Takayuki Kadoya, MD, PhD1, Shigeru Murakami, MD, PhD1, Tsuyoshi Kataoka, MD, PhD2, Masayoshi Fujii, MD3, Koji Arihiro, MD, PhD3  and Morihito Okada, MD, PhD1

1Department of Surgical Oncology Research, Institute for Radiation Biology and Medicine, Hiroshima University

2 Graduate School of Health Sciences, Hiroshima University

3 Department of Anatomical Pathology, Hiroshima University Hospital



Background: We developed a new procedure called hybrid endoscopy-assisted breast-conserving surgery (EBCS), which consists of a combination of plastic surgery and endoscopic surgery techniques. The purpose of this study was retrospectively to analyze the clinical outcome of hybrid EBCS and compare the cosmetic outcomes between hybrid EBCS and conventional breast-conserving surgery (CBCS).

Patients and Methods: We reviewed medical records of patients who had undergone hybrid EBCS (n = 73) or CBCS (n = 90) between May 2005 and April 2011 and had been followed up in our department until March 2012. The clinical outcomes and cosmetic outcomes of these two groups were compared. The safety of hybrid EBCS was also analyzed by confirming its complications and pathological surgical margin.

Results: In the hybrid EBCS group, operation time was longer by 30–50 minutes. Blood loss was not significantly different between the two groups. The surgical margin of hybrid EBCS was as follows: 1 patient (1.4%) had a positive margin, 4 patients (5.5%) had a margin of < 2mm, in 9 patients (12.3%) the margin was q2mm and< 5 mm, and in 59 patients (80.8%) it was q5 mm. Seven cases (9.6%) of postoperative complications occurred in 6 hybrid EBCS patients. To date, no local recurrence has been observed in hybrid EBCS patients (postoperative observation period, 18.1 – 5.6 months). Compared with the CBCS group, the hybrid EBCS group had better cosmetic results, especially with a less noticeable operative scar (P < 0.01).

Conclusions: Hybrid EBCS can provide sufficient free margin, and its surgical curability is acceptable. Additionally, this method is superior to CBCS in terms of cosmetic outcome.

PMID: 23272727



Breast-conserving surgery (BCS) combined with postoperative radiotherapy is a standard therapy for early-stage breast cancer patients. In addition, recent developments in oncoplastic surgery have improved cosmetic outcomes and patient satisfaction. Endoscopy-assisted breast-conserving surgery (EBCS) (Figure), which has the advantage of a less noticeable scar, was developed more than 10 years ago. Recently, some clinical studies have reported the feasibility, oncological outcomes, aesthetic outcomes, and patient satisfaction of EBCS (1).

We developed a new technique called hybrid-EBCS by selecting surgical devices and modifying the method to reduce the need for expensive disposable devices. Here, we report the method used for this technique and its feasibility, surgical curability, risk of complications, and short-term follow-up results. Moreover, we evaluate its cosmetic outcomes in comparison with those of conventional breast-conserving surgery (CBCS).

Our findings suggest that although the operation time for the hybrid-EBCS was longer than that for the CBCS, hybrid-EBCS provided sufficient free margin and its surgical curability was considered equivalent to that of CBCS. Moreover, with regards to cosmetic evaluation, hybrid-EBCS was especially superior because of its less noticeable surgical scar and may contribute to improved postoperative cosmetic outcomes. In addition, this operative method is cost-beneficial as compared to conventional EBCS, because it can be performed with minimal use of disposable devices.

Shinji, Ozaki-fig2

Figure 1. Operative procedure of EBCS
(1) Dissection of the posterior surface of the breast.
(2) Subcutaneous dissection for skin flap construction.
(3) Resection of the mammary gland under light guidance.
(4) Repairing the defect by mobilization of the conserved breast tissue and fat tissue.



  1. Shinji Ozaki, Masahiro Ohara. Endoscopy-assisted breast-conserving surgery for breast cancer patients. Gland Surgery. 2014; 3(2)
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