Robotic nipple-sparing mastectomy: A preliminary report of a single institute and joint collective analysis of current reported series

Abstract

Background: Robotic nipple-sparing mastectomy (R-NSM), which uses the da Vinci surgical platform (Intuitive Surgical, Sunnyvale, CA, USA), could perform NSM and immediate breast reconstruction through small and inconspicuous extramammary axillary incision. Its application in the management of early breast cancer or risk-reducing mastectomy had been reported in some series and a growing number of R-NSM were performed worldwide. The authors would like to present a single-center experience of R-NSM as well as review of the current literature.Materials and Methods: The medical records of patients who underwent R-NSM for breast cancer during the period from March 2017 to July 2018 were retrieved from a prospectively collected database. A review of case series of R-NSM in the current literature were also performed through the PubMed database to determine the effectiveness and oncologic safety of R-NSM.Results: A total of 37 breast cancer patients who received 46 R-NSM procedures were included in the study. Thirty-nine cases (84.8%) were performed for therapeutic purpose. No R-NSM procedure was converted to conventional or endoscopic mastectomy. One (2.6%, 1/39) R-NSM procedure was found to have positive margin involvement. The rate of total nipple-areolar complex (NAC) necrosis was 0%, and no implant loss or local recurrence was observed during a mean follow-up of 10.9 ± 8.2 months. In the joint collective analysis and review of the current literature, a total of 138 R-NSM procedures were available for analysis, and 59 of them were for therapeutic indications. The overall conversion rate was 2.2% (3/138), total NAC necrosis rate was 0%, implant loss rate was 0.8% (1/128), and margin involved rate was 1.7% (1/59). No local recurrence case was reported.Conclusion: From our preliminary experience and review of the current literature, R-NSM is a feasible and safe alternative for NSM in the management of breast cancer. The long-term oncological outcomes, however, will only be determined with longer follow-up.