关键词: 男性乳房发育, 腋窝单孔入路, 腔镜手术, 非溶脂技术, 学习曲线

Abstract: Objective To explore the learning curve and clinical efficacy of modified single-port axillary approach non-liposuction endoscopic gland excision for the treatment of gynecomastia. Methods Clinical data from 68 gynecomastia patients who underwent modified single-port axillary non-liposuction endoscopic gland excision were retrospectively reviewed. All procedures were performed between March 2023 and February 2025. Parameters recorded included unila-teral incision length, operative time, intraoperative blood loss, postoperative drainage duration, postoperative drainage volume, surgical complications, and patient satisfaction. The cumulative sum method was used to plot the learning curve. Differences in related indicators between the growth level group and the master level group were compared. Results All 123 breasts in 68 patients underwent successful surgery. The median unilateral incision length was 5 cm(range: 4-6 cm). The unilateral operative time was(96.46±21.81)min(range: 50-135 min). The median unilateral intraoperative blood loss was 25 mL(range: 5-75 mL). The median unilateral postoperative drainage duration was 7 days(range: 4-12 days). The median unilateral postoperative drainage volume was 216.5 mL(range: 52.0-450.0 mL). All postoperative incisions achieved grade A healing without complications such as infection, fat liquefaction, or nipple and skin necrosis. Ischemic changes of the nipple were noted in 2 patients, subcutaneous hemorrhage occurred in 3 patients, and subcutaneous seroma developed in 5 patients. Patient satisfaction at 3 months postoperatively was 91.2%(62/68). The learning curve was constructed by plotting the cumulative sum analysis of operative times. The inflection point of the curve, which corresponded to 32 cases, was used as the threshold to define two distinct periods: the growth level group(patient IDs: 1-32)and the master level group(patient IDs: 33-68). During the growth level group, the mean unilateral operative time was(106.27±19.36)min(range: 65-135 min)and the median unilateral postoperative drainage duration was 8.25 days(range: 4.50-12.00 days). During the master level group the unilateral operative time was(87.75±20.32)min(range: 50-127.50 min)and the median unilateral postoperative drainage duration was 7 days(range: 4-11.50 days). Statistically significant differences between the two groups were observed in unilateral operative time and postoperative drainage duration(P<0.05). No statistically significant differences were found between the groups regarding age, BMI, incision length, unilateral intraoperative blood loss, unilateral postoperative drainage volume, or complication rates(P>0.05). Conclusion The modified single-port axillary approach non-liposuction endoscopic subcutaneous gland excision is safe and feasible, and the surgeon requires a learning curve of 32 cases to achieve proficiency. This surgical approach significantly reduces operative time, minimizes visible scarring, and is associated with a low rate of postoperative complications while offering superior cosmetic outcomes.

Key words: Gynecomastia, Single-port axillary approach, Laparoscopic surgery, Non-liposuction endoscopic, Learning curve