[Endoscopic surgery for breast diseases: the present state of art and outlook for the future]

Endoscopic breast surgery (EBS) is still not in common use today, mainly because of the lack of intracavitary operative maneuvers in breast surgery. It has been shown, however, that in experienced hands, the therapeutic benefits of EBS include not only improved natural esthetic outcomes but also less morbidity with faster recovery. Endoscopic partial/total mastectomy, axillary dissection, and breast reconstruction can be performed through an axillary incision with an additional periareolar incision depending on the situation, as safe alternatives to conventional operative procedures for early breast cancer. Furthermore, EBS is particularly effective when performing axillary dissection and mobilizing tissue flaps for immediate reconstruction. Since EBS requires the creation of a dissecting working passage and space, which tends to increase operative invasiveness, operating time, and blood loss, in less experienced hands an initial period of learning curve adjustment appears to be mandatory. Safety in terms of adequate local control must be further evaluated and long-term results need to be followed up before EBS can be applied in more advanced-stage breast cancer. Instead of being regarded as a competing technology. EBS should be welcomed and accepted in combination with conventional methods to nurture and further improve the technical aspects of breast cancer surgery. EBS is expected to become an indispensable and integral part of breast surgery in the near future, especially in an era when informed consent is sought with broader patient choice and empowerment models.