Scarless totally implantable venous access port (TIVAP) implantation: Surgical technique, preliminary results, learning curve, and patients-reported outcome in 125 breast cancer patients

Yi-Lin Chang; Chayanee Sae-Lim; Shih-Lung Lin; Hung-Wen Lai; Hsin-I Huang; Yuan-Chieh Lai; Shou-Tung Chen; Dar-Ren Chen

doi:10.1016/j.suronc.2024.102048

Scarless totally implantable venous access port (TIVAP) implantation: Surgical technique, preliminary results, learning curve, and patients-reported outcome in 125 breast cancer patients

Surg Oncol. 2024 Apr:53:102048. doi: 10.1016/j.suronc.2024.102048. Epub 2024 Feb 14.

Authors

Yi-Lin Chang¹, Chayanee Sae-Lim², Shih-Lung Lin³, Hung-Wen Lai⁴, Hsin-I Huang⁵, Yuan-Chieh Lai⁶, Shou-Tung Chen⁷, Dar-Ren Chen⁸

Affiliations

¹ Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan. Electronic address: [email protected].
² Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Electronic address: [email protected].
³ Division of Plastic and Reconstructive Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: [email protected].
⁴ Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan; Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: [email protected].
⁵ Department of Information Management, National Sun-Yat-Sen University, Kaohsiung, Taiwan. Electronic address: [email protected].
⁶ School of Medicine, Chung Shan Medical University, Taichung, Taiwan. Electronic address: [email protected].
⁷ Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: [email protected].
⁸ Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: [email protected].

PMID: 38412756
DOI: 10.1016/j.suronc.2024.102048

Abstract

Background: Minimal-access (endoscopic or robotic-assisted) breast surgery has been increasingly performed and shown better cosmetic results. However, location of totally implantable venous access port (TIVAP) for systemic treatment at anterior chest may compromise its aesthetic benefits. Therefore, we proposed a new scarless technique for TIVAP implantation, and reported the preliminary results, learning curve, and patients-surveyed outcome.

Methods: Surgical technique of the new "scarless" TIVAP implantation was proposed. Patients receiving this procedure in a single institution were included. The preliminary results of the scarless TIVAP implantation, learning curve, and patient-reported outcome were analyzed and reported.

Results: A total of 125 breast cancer patients received scarless TIVAP procedures were enrolled. The primary success rate of the scarless TIVAP implantation was 100%. Mean operative time was 46 ± 14 min. Mean amount of blood loss was 8.5 ± 3.2 ml. The cumulative sum plot showed operation time significantly decreased after 24th cases. In the initial learning phase, the mean operative time was 55 ± 17 min, and decreased to 43 ± 12 min in the later mature phase (P = 0.003). There were 5 (4%) complications detected, which included 1 (0.8%) seroma formation, 2 (1.6%) revisions, and 2 (1.6%) unplanned explantations. From patients-evaluated questionnaires, more than 90% of responders were satisfied with aesthetic results, experience during surgery, and application of scarless TIVAP for systemic therapy.

Conclusions: The scarless TIVAP implantation is a safe & reliable procedure with high patients-reported aesthetic satisfaction, and could be an alternative TIVAP procedure for patients requiring chemotherapy and desiring a less noticeable scar.

Keywords: Endoscopy-assisted breast surgery (EABS); Minimal access breast surgery (MABS); Robotic assisted breast surgery (RABS); Scarless TIVAP; Totally implantable venous-access ports (TIVAP).

MeSH terms

Breast Neoplasms* / drug therapy
Breast Neoplasms* / surgery
Catheterization, Central Venous* / adverse effects
Catheters, Indwelling / adverse effects
Endoscopy
Female
Humans
Learning Curve
Patient Reported Outcome Measures