Single-Incision Endoscopic Breast Conservation Surgery with Sentinel Lymph Node Biopsy: Early Indian Experience

This video demonstrates a single-incision endoscopic breast conservation surgery (EBCS) combined with sentinel lymph node biopsy (SLNB) performed for early-stage invasive breast carcinoma.

Breast-conserving surgery remains the standard of care for early breast cancer; however, conventional techniques often result in visible scars and suboptimal cosmetic outcomes. Endoscopic approaches allow tumor excision through concealed incisions while maintaining oncologic safety.

This procedure represents one of the early structured experiences from India, highlighting a minimally invasive, cost-effective technique utilizing standard laparoscopic instruments and a glove-port system.

The surgical steps demonstrated include:

Preoperative tumor localization using ultrasound guidance
Sentinel lymph node mapping using indocyanine green (ICG) dye
Axillary incision and SLNB using a dual-dye technique
Creation of working space using hydrodissection and subcutaneous tunneling
Glove-port placement with CO₂ insufflation (8–10 mmHg)
Endoscopic dissection using monopolar instruments
Ultrasound-guided tumor excision and intraoperative margin assessment
Frozen section confirmation of margins
Intracorporeal glandular reconstruction
Subcuticular wound closure with concealed scar

In the presented case, complete tumor excision with negative margins and successful sentinel lymph node retrieval was achieved.

This technique offers several advantages:

Hidden axillary incision with no visible breast scar
Enhanced visualization with magnified endoscopic view
Preservation of breast contour
Reduced morbidity compared to conventional approaches

Clinical outcomes from our series demonstrate:

100% negative margins
Mean blood loss approximately 60 ml
High cosmetic satisfaction (Likert score ~4.6/5)
No early recurrence on follow-up

This video highlights the feasibility, safety, and oncologic adequacy of single-incision EBCS in selected patients and demonstrates its potential as a cost-effective alternative to robotic breast surgery in resource-limited settings.