Ultrasonography-guided single-port transaxillary endoscopic excision for breast fibroadenoma: a retrospective comparative study of technical feasibility and early outcomes

BACKGROUND: Intraoperative ultrasonography may compensate for the loss of direct palpation during concealed transaxillary endoscopic excision of breast fibroadenoma. This study assessed the feasibility and early outcomes of this ultrasound-guided remote access technique compared with conventional open excision. METHODS: Twenty women with breast fibroadenoma underwent single-port transaxillary endoscopic excision with intraoperative ultrasonographic guidance (n = 10) or conventional open excision (n = 10). Outcomes included operative time, blood loss, incision length, postoperative pain, hospital stay, complications, residual lesion on postoperative ultrasonography, and selected BREAST-Q domains. RESULTS: Endoscopic excision was completed in all patients without conversion. In all endoscopic cases, intraoperative ultrasonography was used to re-identify the target lesion after working-space creation, and repeat ultrasonography confirmed no sonographically visible residual lesion after tumor removal. No residual lesion was detected on postoperative ultrasonography in either group. Compared with open excision, the endoscopic approach showed longer operative time (mean difference [MD], 64.8 min; 95% CI, 42.2 to 87.4; Hedges g = 2.62), higher 24-hour postoperative pain scores (MD, 2.3 points; 95% CI, 1.2 to 3.4; Hedges g = 1.97), and longer institution-specific hospital stay (MD, 2.0 days; 95% CI, 1.0 to 3.0; Hedges g = 1.81). Estimated intraoperative blood loss was lower in the endoscopic group (MD, -10.3 mL; 95% CI, -14.2 to -6.4; Hedges g = -2.44), although the absolute difference was small and should not be interpreted as a major clinical advantage. Incision length and 30-day complication rates showed limited between-group separation. At 3 months, patient-reported psychosocial well-being, breast satisfaction, and scar satisfaction scores were numerically higher in the endoscopic group. CONCLUSION: In this small retrospective proof-of-concept cohort, single-port transaxillary endoscopic excision with intraoperative ultrasonographic guidance was technically feasible in selected patients with breast fibroadenoma and enabled complete excision without sonographically visible residual lesions. However, this concealed-access approach involved longer operative time, higher early postoperative pain, and longer institution-specific hospitalization than conventional open excision. Its potential role should therefore be framed as a selected cosmetic and image-guided surgical option rather than a broadly superior alternative to open excision.