Clinical Perspectives on Robot-assisted Nipple-sparing Mastectomy

Abstract Seeking smaller and indistinct incisions, physicians have attempted endoscopic breast surgery in breast cancer patients. Unfortunately, there are some limitations in the range of movement and visualization of the operation field. Potentially addressing these limitations, we investigated the outcomes of gas and gasless robot-assisted nipple-sparing mastectomy (RANSM) with immediate breast reconstruction (IBR). Ten patients underwent 12 RANSM with IBR between November 2016 and April 2018. Patients with tumors measuring >5 cm in diameter, tumor invasion of the skin or nipple-areolar complex, proven metastatic lymph nodes, or planned radiotherapy were excluded. Age, breast weight, diagnosis, tumor size, hormone receptor status, and operation time were retrospectively collected. Postoperative outcomes including postoperative complications and final margin status of resected were analyzed. The median total operation time and console time were 351 min (267–480 min) and 51 min (18–143 min), respectively. The learning curve presented as a cumulative sum graph showed that the console time decreased and then stabilized at the eighth case. There was no open conversion or major postoperative complication. One patient had self-resolved partial nipple ischemia, and two patients experienced partial skin ischemia. We deemed that RANSM with IBR is safe and feasible for early breast cancer, benign disease of the breast, and BRCA 1/2 mutation carriers. RANSM is an advanced surgical method with a short learning curve.

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Prospective pilot study protocol evaluating the safety and feasibility of robot-assisted nipple-sparing mastectomy (RNSM)

BMJ Open ◽

10.1136/bmjopen-2021-050173 ◽

2021 ◽

Vol 11 (11) ◽

pp. e050173

Author(s):

Ko Un Park ◽

Sandy Lee ◽

Angela Sarna ◽

Matthew Chetta ◽

Steven Schulz ◽

...

Keyword(s):

Pilot Study ◽

Descriptive Analysis ◽

Robot Assisted ◽

En Bloc ◽

Prospective Pilot Study ◽

Link Type ◽

Areolar Complex ◽

Reference Number ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

IntroductionNipple-sparing mastectomy (NSM) can be performed for the treatment of breast cancer and risk reduction, but total mammary glandular excision in NSM can be technically challenging. Minimally invasive robot-assisted NSM (RNSM) has the potential to improve the ergonomic challenges of open NSM. Recent studies in RNSM demonstrate the feasibility and safety of the procedure, but this technique is still novel in the USA.Methods and analysisThis is a single-arm prospective pilot study to determine the safety, efficacy and potential risks of RNSM. Up to 12 RNSM will be performed to assess the safety and feasibility of the procedure. Routine follow-up visits and study assessments will occur at 14 days, 30 days, 6 weeks, 6 months and 12 months. The primary outcome is to assess the feasibility of removing the breast gland en bloc using the RNSM technique. To assess safety, postoperative complication information will be collected. Secondary outcomes include defining benefits and challenges of RNSM for both surgeons and patients using surveys, as well as defining the breast and nipple-areolar complex sensation recovery following RNSM. Mainly, descriptive analysis will be used to report the findings.Ethics and disseminationThe RNSM protocol was reviewed and approved by the US Food and Drug Administration using the Investigational Device Exemption mechanism (reference number G200096). In addition, the protocol was registered with ClinicalTrials.gov (NCT04537312) and approved by The Ohio State University Institutional Review Board, reference number 2020C0094 (18 August 2020). The results of this study will be distributed through peer-reviewed journals and presented at surgical conferences.Trial registration numberNCT04537312.

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Comparison between Gasless and Gas-Inflated Robot-Assisted Nipple-Sparing Mastectomy

Journal of Breast Cancer ◽

10.4048/jbc.2021.24.e20 ◽

2021 ◽

Vol 24 ◽

Author(s):

Haemin Lee ◽

Jeea Lee ◽

Kwanbum Lee ◽

Jee Ye Kim ◽

Hyung Seok Park

Keyword(s):

Robot Assisted ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

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Robot-assisted Nipple-sparing Mastectomy with Immediate Breast Reconstruction

Annals of Surgery ◽

10.1097/sla.0000000000004492 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Jai Min Ryu ◽

Jee Ye Kim ◽

Hee Jun Choi ◽

Beom Seok Ko ◽

Jisun Kim ◽

...

Keyword(s):

Breast Reconstruction ◽

Immediate Breast Reconstruction ◽

Robot Assisted ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

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Residual breast tissue after robot-assisted nipple sparing mastectomy

The Breast ◽

10.1016/j.breast.2020.11.022 ◽

2021 ◽

Vol 55 ◽

pp. 25-29

Author(s):

Ko Un Park ◽

Gary H. Tozbikian ◽

David Ferry ◽

Allan Tsung ◽

Mathew Chetta ◽

...

Keyword(s):

Breast Tissue ◽

Robot Assisted ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

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Robot-assisted nipple-sparing mastectomy with immediate breast reconstruction: an initial experience

The Breast ◽

10.1016/s0960-9776(19)30362-5 ◽

2019 ◽

Vol 44 ◽

pp. S106

Author(s):

H.S. Park ◽

J. Lee ◽

H. Lee ◽

K.B. Lee ◽

K. Yoon ◽

...

Keyword(s):

Breast Reconstruction ◽

Immediate Breast Reconstruction ◽

Initial Experience ◽

Robot Assisted ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

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Author Correction: Robot-assisted Nipple-sparing Mastectomy with Immediate Breast Reconstruction: An Initial Experience

Scientific Reports ◽

10.1038/s41598-020-64238-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hyung Seok Park ◽

Jeea Lee ◽

Dong Won Lee ◽

Seung Yong Song ◽

Dae Hyun Lew ◽

...

Keyword(s):

Breast Reconstruction ◽

Immediate Breast Reconstruction ◽

Initial Experience ◽

Robot Assisted ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

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Single-port robot-assisted prosthetic breast reconstruction with the da Vinci SP Surgical System: first clinical report

Archives of Plastic Surgery ◽

10.5999/aps.2020.01557 ◽

2021 ◽

Vol 48 (2) ◽

pp. 194-198

Author(s):

Oh Young Joo ◽

Seung Yong Song ◽

Hyung Seok Park ◽

Tai Suk Roh

Keyword(s):

Breast Reconstruction ◽

Da Vinci ◽

Invasive Technique ◽

Clinical Report ◽

Robot Assisted ◽

Immediate Reconstruction ◽

Open Conversion ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing ◽

Surgical System

Robot-assisted nipple-sparing mastectomy with immediate reconstruction is currently performed in an attempt to seek smaller and indistinct incisions. Robotic surgery system has been evolving under the concept of minimal invasive technique which is a recent trend in surgery. One of the latest version is the da Vinci SP Surgical System (Intuitive Surgical). In this report, we will share our experiences. Two patients underwent robot-assisted nipple-sparing mastectomy, each followed by immediate robot-assisted expander insertion and prepectoral direct-to-implant breast reconstruction, respectively. There was no open conversion or major postoperative complication. One patient experienced mild infection, which was resolved by intravenous antibiotic treatment. Simple docking process, multi-joint instruments, and third-arm functionality are among the new surgical system’s advantages. The present cases suggest that robot-assisted nipple-sparing mastectomy with immediate reconstruction using the da Vinci SP Surgical System is feasible and safe. The promising features and potential application of da Vinci SP in breast reconstruction need further study.

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Robotic harvest of a latissimus dorsi flap using a single-port surgical robotic system in breast reconstruction

Archives of Plastic Surgery ◽

10.5999/aps.2021.00710 ◽

2021 ◽

Vol 48 (6) ◽

pp. 577-582

Author(s):

Oh Young Joo ◽

Seung Yong Song ◽

Dae Hyun Lew ◽

Hyung Seok Park ◽

Dong Won Lee

Keyword(s):

Minimally Invasive ◽

Breast Reconstruction ◽

Latissimus Dorsi ◽

Single Port ◽

Immediate Breast Reconstruction ◽

Robot Assisted ◽

Invasive Approach ◽

Robotic Arms ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

Robot-assisted surgery is evolving to incorporate a higher number of minimally invasive techniques. There is a growing interest in robotic breast reconstruction that uses autologous tissue. Since a traditional latissimus dorsi (LD) flap leads to a long donor scar, which can be an unpleasant burden to patients, there have been many attempts to decrease the scar length using minimally invasive approaches. This study presents the case of a patient who underwent a robot-assisted nipple-sparing mastectomy followed by immediate breast reconstruction with an LD flap using a single-port robotic surgery system. With the assistance of a single-port robot, a simple docking process using a short and less visible incision is possible. Compared to multiport surgery systems, single-port robots can reduce the possibility of collision between robotic arms and provide a clear view of the medial border of the LD where the curvature of the back restricts the visual field. We recommend the use of single-port robots as a minimally invasive approach for harvesting LD flaps.

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