Robotic nipple sparing mastectomy through a single incision: Advantages of starting with posterior dissection
Cihan Uras2
, Akif Enes Arıkan1, Halil Kara4, Onur Dülgeroğlu4, Yakup Avşar6
1Acibadem Mehmet Ali Aydinlar University, School Of Medicine, Department Of General Surgery, Istanbul, Turkey
2Acibadem Mehmet Ali Aydinlar University, Research Institute Of Senology, Istanbul, Turkey
3Acibadem Maslak Hospital, Department Of General Surgery, Division Of Breast Health And Diseases, Istanbul, Turkey
4Acibadem Mehmet Ali Aydinlar University, Vocational School Of Health Sciences, Istanbul, Turkey
5Acibadem Atakent Hospital, Department Of General Surgery, Division Of Breast Health And Diseases, Istanbul, Turkey
6Private Avşar Clinic, -, Istanbul, Turkey
Abstract
Objective: Loss of breast, which is an important body marking of women, causes a huge decrease in quality of life (QoL) after treatment. In order to overcome this morbidity and increase QoL, nipple sparing mastectomy (NSM) has been developed. Even though the demand for better cosmetic results has yielded endoscopic nipple sparing mastectomy, limitations like unsuitable optical window and limited manual control of rigid-tip instruments, and struggling to keep dissection space have led robotic nipple sparing mastectomy (rNSM) to be developed.
Materials and Methods: Records of three patients who underwent to rNSM for invasive breast carcinoma with DaVinci Xi (Intuitive Surgical, Sunnyvale, CA) in affiliated hospitals of xxxxx xxxxx xxx xxxx University, Research Institute of xxxxx in 2018 were investigated retrospectively. In all breasts (n=4), dissection was started from the posterior side of breast.
Results: In the unit, 738 breast cancer patients underwent surgery between 2018 and 2019 with an NSM ratio of 31.4% (n=232). Of these patients, three underwent rNSM with DaVinci Xi robotic system. The operation was performed on the left breast in one patient, right in one, and bilateral in one patient. Only in patient #2, who was a neoadjuvant chemotherapy recipient, seroma was observed six weeks after surgery (3 weeks after removal of drains) and spontaneously resolved in 4 weeks. No other complication was seen in all patients. In the follow-up period of median 21 months, no loco-regional recurrence or distant metastasis was seen.
Conclusion: A single incision robotic mastectomy can be performed easily and safely when the dissection starts from the pre-pectoral plane rather than the subcutaneous plane.
Keywords: Breast, Robotic Surgical Procedure, Minimally Invasive Surgical Procedures
Ethics committee approval was received for this study from Clinical Research Evaluation Ethical Board (2019-11/24).
Externally peer-reviewed.
Concept - C.U., A.E.A, H.K., O.D., Y.A.; Design - C.U., A.E.A, H.K.; Supervision - C.U., Y.A.; Resource - C.U., A.E.A, H.K., O.D., Y.A.; Mate- rials - C.U., Y.A.; Data Collection and/or Processing - A.E.A., H.K., O.D.; Analysis and Interpretation - A.E.A., O.D.; Literature Review - H.K., O.D.; Writing Ma- nuscript - C.U., A.E.A, H.K., O.D., Y.A.; Critical Reviews - C.U., A.E.A, H.K., O.D., Y.A.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.