Clement Luck Khng Chia

Background: Conventional monopolar electrosurgery is widely used in breast surgery but is associated with collateral thermal injury, which may contribute to impaired wound healing, increased drainage and compromised pathological assessment. Low-thermal electrosurgical devices have been developed to minimise thermal spread while maintaining effective tissue dissection and haemostasis. However, the clinical evidence supporting their use in breast surgery remains fragmented. Objective: To systematically map and synthesise the available literature evaluating low-thermal monopolar electrosurgical devices compared with conventional monopolar electrocautery or scalpel in breast surgery. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches were performed in PubMed, Embase, Scopus, Web of Science and IEEE Xplore. Eligible studies included clinical investigations involving breast surgery that compared low-thermal monopolar electrosurgical devices with conventional monopolar electrocautery or scalpel and reported operative, pathological, clinical or patient-reported outcomes. Results: A total of 515 records were identified, of which 13 studies met the inclusion criteria. Most studies evaluated the PEAK PlasmaBlade ([Formula: see text]), while limited evidence was available for helium plasma radiofrequency devices, argon plasma coagulation and the ACE blade. Across studies, plasma-assisted electrosurgical systems consistently demonstrated reduced thermal injury depth compared with conventional electrocautery. Reported clinical benefits included reduced drainage volume, shorter drain duration, improved skin flap perfusion, lower rates of selected wound complications and improved pathological margin assessment. However, findings for clinical outcomes were heterogeneous and frequently derived from small, underpowered studies. Evidence for non-plasma-assisted electrosurgical technologies was sparse and largely limited to descriptive or exploratory studies. Conclusions: Current evidence suggests that low-thermal monopolar electrosurgical devices may reduce collateral thermal injury and offer potential perioperative advantages in breast surgery. Nevertheless, the available literature is limited by small sample sizes, heterogeneity of outcome measures and a paucity of comparative effectiveness and economic data. Further well-designed prospective studies are required to establish the clinical and cost-effectiveness of these technologies and to define their role in contemporary breast surgical practice.

Background: Breast cancer remains the most diagnosed malignancy and a leading cause of cancer death among women globally, with a rising burden in older populations. Women aged ≥65 years account for over a third of new breast cancer diagnoses and nearly half of related deaths. These individuals often face unique challenges underscoring the need for individualised care strategies that prioritise quality of life (QoL). An increasing body of research suggests that the use of smartphone and wearable-based digital biomarkers demonstrated benefits like symptom management and improved QoL. This systematic review aims to evaluate the feasibility of smartphone and wearable-based digital biomarkers and their use in assessing QoL for older women with breast cancer. Methods: Literature searches were performed across PubMed, Embase, and Scopus up to March 2025. Eligible studies included women aged ≥65 years with a breast cancer diagnosis, evaluating the use of smartphone applications or wearable technologies, and assessing QoL. Study selection, data extraction, and risk of bias assessment were conducted independently by two reviewers, with consensus reached via a third. Results: Four studies met inclusion criteria, involving a total of 380 women with breast cancer. The studies were published between 2021 and 2024. Two studies were conducted in the United States, and one study each in Germany and Japan. Three were prospective studies, with one randomised controlled trial included. All four studies were related to the use of smartphone application, not a single study involved the use of wearable based digital biomarkers. Conclusions: Smartphone applications show significant potential in enhancing the care in older women with breast cancer, especially in symptom monitoring, medication adherence and QoL. However, due to the unique needs and treatment complexities of this population, individualised approaches are essential. Future research should prioritise age-inclusive, large-scale, high-quality studies to address the significant existing gap in research such as its cost-effectiveness and effects on survival. Integrating digital tools into geriatric oncology could enhance personalised care, but further research is needed to validate their impact on outcomes and guide implementation in clinical practice.

Breast cancer mortality has declined steadily over the years with breast cancer screening and improvement in diagnostic and therapeutic regimens. Despite cancer survivors living longer, breast cancer-related lymphedema (BCRL) is a significant complication after major breast surgery that can impact quality of life adversely. The incidence of BCRL reported ranges from 10.1% to 42.2%1-5 with risk factors that include higher body mass index, larger number of dissected nodes, taxane-based regimen, total mastectomy, larger irradiation field, and conventional fractionation.5 To mitigate the risk of BCRL, de-escalating axilla surgery and axilla radiotherapy in place of axillary dissection are increasingly recognised as the new standard of care in recent years for early breast cancer with sentinel lymph node positive.6 Surgical innovation and advancements have also led to proponents of immediate lymphatic reconstruction to decrease the incidence of BCRL.7 However, immediate lymphatic reconstruction is a costly additional procedure and whether it constitutes value-based care to recommend this as a routine procedure in relation to the prevalence of lymphedema in Singapore is an important decision that requires careful deliberation by the breast cancer surgical community.

Breast cancer is the world’s most prevalent cancer, and many breast cancer patients undergo mastectomy as the choice of treatment, often with post-ma

Background: Minimal-accessed (robotic and endoscopic) breast cancer surgery is increasingly performed due to better cosmetic results and acceptable oncological outcomes. This study aims to demonstrate the clinical safety and patient-reported cosmetic satisfaction of single-port three-dimensional endoscopic-assisted breast surgery (S-P 3D EABS), which is our new endoscopic surgical innovation, in both malignant and benign breast conditions. Methods: Patients who underwent S-P 3D EABS from 1 August 2018 to 31 July 2022 in a single institution were enrolled. Clinical outcomes of this procedure were retrospectively reviewed, and the patient-reported cosmetic satisfaction was evaluated by a questionnaire and reported herein. Results: During the study period, 145 patients underwent 164 procedures of S-P 3D EABS. One hundred fifty (91.5%) procedures were endoscopic-assisted nipple-sparing mastectomy (S-P 3D E-NSM; 117 therapeutic procedures for breast cancer, 13 prophylactic mastectomies, 20 procedures for gynecomastia). Fourteen (8.5%) procedures of endoscopic-assisted breast-conserving surgery (S-P 3D E-BCS) were performed (12 S-P 3D E-BCS, 2 S-P 3D E-BCS with 3D videoscope-assisted partial breast reconstruction, which was 1 case of latissimus dorsi flap and 1 case of omental flap). The mean operative time was 245 ± 110 min in S-P 3D E-NSM and 260 ± 142 min in S-P 3D E-BCS. The mean intraoperative blood loss was 49.7 ± 46.9 ml in S-P 3D E-NSM and 32.8 ± 17.5 ml in S-P 3D E-BCS. Subnipple biopsy showed positive malignancy in 3 (2.6%) S-P 3D E-NSM patients. None of the S-P 3D E-BCS patients found margin involvement; however, 3 (2.6%) reported margin involvement in S-P 3D E-NSM patients. Thirty-two complications were found (24.6%): 7 (5.3%) transient nipple-areolar complex (NAC) ischemia, 7 (5.3%) partial NAC necrosis, 1 (0.7%) total NAC necrosis, and 1 (0.7%) implant loss. During the mean follow-up time of 34 months, there were 2 (1.5%) patients with locoregional recurrence, 9 (6.9%) distant metastasis, and 2 (1.5%) mortality. 78.6% (77/98) of patients answering the cosmetic-evaluated questionnaire reported good and excellent overall satisfaction. Conclusions: S-P 3D EABS is a novel surgical innovation, which is able to perform safely in either malignant or benign breast conditions and offer promising cosmetic results.

Introduction Online multiple-choice question (MCQ) quizzes are popular in medical education due to their ease of access and ability for test-enhanced learning. However, a general lack of motivation among students often results in decreasing usage over time. We aim to address this limitation by developing Telegram Education for Surgical Learning and Application Gamified (TESLA-G), an online platform for surgical education that incorporates game elements into conventional MCQ quizzes. Methods and analysis This online, pilot randomised control trial will be conducted over 2 weeks. Fifty full-time undergraduate medical students from a medical school in Singapore will be recruited and randomised into an intervention group (TESLA-G) and an active control group (non-gamified quizzing platform) with a 1:1 allocation ratio, stratified by year of study. We will evaluate TESLA-G in the area of endocrine surgery education. Our platform is designed based on Bloom’s taxonomy of learning domains: questions are created in blocks of five questions per endocrine surgery topic, with each question corresponding to one level on Bloom’s taxonomy. This structure promotes mastery while boosting student engagement and motivation. All questions are created by two board-certified general surgeons and one endocrinologist, and validated by the research team. The feasibility of this pilot study will be determined quantitatively by participant enrolment, participant retention and degree of completion of the quizzes. The acceptability of the intervention will be assessed quantitatively by a postintervention learner satisfaction survey consisting of a system satisfaction questionnaire and a content satisfaction questionnaire. The improvement of surgical knowledge will be assessed by comparing the scores of preintervention and postintervention knowledge tests, which consist of separately created questions on endocrine surgery. Retention of surgical knowledge will be measured using a follow-up knowledge test administered 2 weeks postintervention. Finally, qualitative feedback from participants regarding their experience will be obtained and thematically analysed. Ethics and dissemination This research is approved by Singapore Nanyang Technological University (NTU) Institutional Review Boards (Reference Number: IRB-2021-732). All participants will be expected to read and sign a letter of informed consent before they are considered as recruited into the study. This study poses minimal risk to participants. Study results will be published in peer-reviewed open-access journals and presented in conference presentations. Trial registration number NCT05520671.

Old age is associated with increased co-morbidities, resulting in reduced life expectancy. Primary endocrine therapy is an alternative to primary surgical therapy for patients with breast cancer and increased co-morbidities. The aim was to review outcomes of primary endocrine therapy versus primary surgical therapy in older women with breast cancer. PubMed, Embase (Ovid), Scopus, and the Cochrane Library were searched systematically from January 2000 to May 2022. Single-arm studies were excluded. Primary outcomes were overall survival and breast cancer-specific survival. Secondary outcomes were local and regional failure of primary endocrine therapy, recurrence after primary surgical therapy, and health-related quality of life. There were 14 studies including 14 254 patients (primary endocrine therapy 2829, 19.8 per cent; primary surgical therapy 11 425, 80.2 per cent), with the addition of four major studies (9538 patients) compared with the latest review in 2014. Seven studies defined primary surgical therapy as surgery plus adjuvant endocrine therapy, and six studies included patients with oestrogen receptor-positive tumours only. Patients in the primary endocrine therapy group were older than the primary surgical therapy group (mean difference 2.43 (95 per cent c.i. 0.73 to 4.13) years). Primary endocrine therapy led to worse overall survival than primary surgical therapy (HR 1.42, 95 per cent c.i. 1.06 to 1.91). Subgroup analysis of RCTs and prospective studies, however, showed comparable overall survival. Breast cancer-specific survival was also comparable (HR 1.28, 95 per cent c.i. 0.87 to 1.87). At 6 weeks, operated patients had significant arm symptoms and illness burden following major breast surgery compared with patients receiving primary endocrine therapy. Health-related quality of life, measured by the European Organization for Research and Treatment of Cancer QLQ-C30 and EuroQol EQ-5D-5L™, was comparable in the two treatment groups. Overall survival was worse among older women receiving primary endocrine therapy in an analysis including all studies, but comparable in RCTs and prospective studies. This may be due to confounding by age and co-morbidities in retrospective cohort studies of primary endocrine therapy.