Early experiences with robot-assisted prosthetic breast reconstruction

Robotic surgery facilitates surgical procedures by employing flexible arms with multiple degrees of freedom and providing high-quality 3-dimensional imaging. Robot-assisted nipplesparing mastectomy with immediate reconstruction is currently performed to avoid breast scars. Four patients with invasive ductal carcinoma underwent robot-assisted nipple-sparing mastectomy and immediate robot-assisted expander insertion. Through a 6-cm incision along the anterior axillary line, sentinel lymph node biopsy and nipple-sparing mastectomy were performed by oncologic surgeons. The pectoralis major muscle was elevated, an acellular dermal matrix (ADM) sling was created with robotic assistance, and an expander was inserted into the subpectoral, sub-ADM pocket. No patients had major complications such as hematoma, seroma, infection, capsular contracture, or nipple-areolar necrosis. The mean operation time for expander insertion was 1 hour and 20 minutes, and it became shorter with more experience. The first patient completed 2-stage prosthetic reconstruction and was highly satisfied with the unnoticeable scar and symmetric reconstruction. We describe several cases of immediate robot-assisted prosthetic breast reconstruction. This procedure is a feasible surgical option for patients who want to conceal surgical scars.

Keywords

Robotic surgical procedures - Mammaplasty - Breast implants - Tissue expansion devices

Publication History

Received: 09 January 2018

Accepted: 10 July 2018

Article published online:
28 March 2022

• REFERENCES

• 1 Gerber B, Krause A, Dieterich M. et al. The oncological safety of skin sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction: an extended follow-up study. Ann Surg 2009; 249: 461-8
• 2 Petit JY, Veronesi U, Rey P. et al. Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat 2009; 114: 97-101
• 3 Sakamoto N, Fukuma E, Higa K. et al. Early results of an endoscopic nipple-sparing mastectomy for breast cancer. Ann Surg Oncol 2009; 16: 3406-13
• 4 Leff DR, Vashisht R, Yongue G. et al. Endoscopic breast surgery: where are we now and what might the future hold for video-assisted breast surgery?. Breast Cancer Res Treat 2011; 125: 607-25
• 5 Dziegielewski PT, Kang SY, Ozer E. Transoral robotic surgery (TORS) for laryngeal and hypopharyngeal cancers. J Surg Oncol 2015; 112: 702-6
• 6 Toesca A, Peradze N, Manconi A. et al. Robotic nipple-sparing mastectomy for the treatment of breast cancer: feasibility and safety study. Breast 2017; 31: 51-6
• 7 Toesca A, Peradze N, Galimberti V. et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with implant: first report of surgical technique. Ann Surg 2017; 266: e28-30
• 8 Park HS, Lee DW, Kim JH. et al. The first case report of robot-assisted nipple sparing mastectomy and immediate reconstruction in Korea. In: Proceeding of Annual Meeting of Global Breast Cancer Conference 2017 (GBCC 2017) 04/2017. -20 22 Jeju, Korea:
• 9 Kang SW, Chung WY. Transaxillary single-incision robotic neck dissection for metastatic thyroid cancer. Gland Surg 2015; 4: 388-96
• 10 Kang SW, Jeong JJ, Yun JS. et al. Robot-assisted endoscopic surgery for thyroid cancer: experience with the first 100 patients. Surg Endosc 2009; 23: 2399-406
• 11 Song HG, Yun IS, Lee WJ. et al. Robot-assisted free flap in head and neck reconstruction. Arch Plast Surg 2013; 40: 353-8
• 12 Selber JC, Baumann DP, Holsinger FC. Robotic latissimus dorsi muscle harvest: a case series. Plast Reconstr Surg 2012; 129: 1305-12
• 13 Chung JH, You HJ, Kim HS. et al. A novel technique for robot assisted latissimus dorsi flap harvest. J Plast Reconstr Aesthet Surg 2015; 68: 966-72
• 14 Gottlieb A, Sprung J, Zheng XM. et al. Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation. Anesth Analg 1997; 84: 1154-6
• 15 Baik SH, Kwon HY, Kim JS. et al. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol 2009; 16: 1480-7