Residual breast tissue after robot-assisted nipple sparing mastectomy

Park, Ko Un; Tozbikian, Gary; Ferry, David; Tsung, Allan; Chetta, Mathew; Schulz, Steven; Skoracki, Roman J.

doi:10.1016/j.breast.2020.11.022

Cited by 14 publications

(9 citation statements)

References 34 publications

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“…The ET has limitations in terms of negotiating the convex contour of the posterior chest wall and difficulty maintaining an optical window, which leads to operational difficulty, insufficient LDMF volume, and a prolonged operation time ( 3 , 5 ). The RT improves visualization and surgical dexterity but is still not as good as open surgery ( 6 ). Additionally, the RT has the disadvantages of high costs and a doubled docking time caused by changes in the patient’s position ( 3 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery

Wen¹,

Xie²,

Feng³

et al. 2022

Gland Surg

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Background: A novel endoscopic-assisted technique (NET) was created by our team for nipple-sparing mastectomy (NSM) and latissimus dorsi muscle flap (LDMF) reconstruction that enables the procedure to be conducted through a single axillary incision. The authors hypothesized that the NET has the advantages of the traditional ET (TET) and a reduced operation time. The purpose of this study is to compare the advantages and disadvantages of NET, TET and open surgery. Methods: A retrospective cohort study was performed on patients who underwent LDMF reconstruction after NSM using open surgery, the TET, or the NET between January 2013 and June 2021. The following outcomes were compared: the operation time, size of the LDMF, the complication rate, hospital length of stay, hospital costs, aesthetic results (the BREAST-Q questionnaire), and quality of life (QoL). The BREAST-Q questionnaire and QoL were underwent preoperatively and 1, 3, and 12 months postoperatively. Results: A total of 17 ETs (comprising 10 NETs and 7 TETs) and 28 open surgery procedures were identified and analyzed, the baseline characteristics were comparable in terms of age, BMI, tumor location, cup size, and disease stage of the three groups. The mean operation time of the NET group (395.8±176.0 min) in the exploration stage was shorter than that of the TET group (531.6±69.6 min) and equivalent to that of the open surgery group (400.9±67.3 min). The overall postoperative complication rates of the ET and open surgery groups were 35.3% and 60.7%, respectively (P=0.09). The aesthetic results in relation to patients' satisfaction with their breasts (P=0.001) and backs (P=0.001) were better in the ET group than the open surgery group beginning at 1 month postoperatively. The ET group had better psychosocial well-being beginning at 1 month postoperatively (P=0.002) and sexual well-being beginning at 3 months postoperatively (P<0.001) than the open surgery group.Conclusions: LDMF reconstruction after NSM using the ET is associated with lower complication rates, good aesthetic results, and a better QoL than open surgery procedures. The NET is a promising approach, a more convenient procedure, and has a shorter surgery time than TET, however, this conclusion needs to be further validated by RCT research with a larger sample size.

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Section: Introductionmentioning

confidence: 99%

Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery

Wen¹,

Xie²,

Feng³

et al. 2022

Gland Surg

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“…To study the technical feasibility and safety of RNSM, we performed a series of cadaveric RNSM and assessed the mastectomy flap for the presence of residual breast tissue. 16 We were able to demonstrate that RNSM is technically feasible. Residual breast tissue was only detectable in the NAC, and none was detectable in the mastectomy flap outside the NAC.…”

Section: Introductionmentioning

confidence: 84%

“…Eligible patients will undergo RNSM as previously described. 16 Briefly, the anterior axillary incision will be used for dissection. The breast incision, measuring approximately 3 cm, will be placed just lateral to the anterior axillary line.…”

Section: Methods and Analysismentioning

confidence: 99%

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

et al. 2021

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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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“…Residual breast tissue (RBT) after mastectomy can contribute to breast cancer recurrence and serve as a surrogate marker for surgical oncological outcomes (Griepsma et al , 2014). Park et al (2021) conducted a study on RBT after RNSM and reported that RNSM was feasible, leaving minimal RBT in the mastectomy flap. Although additional large-scale studies are needed on RBT after RNSM, minimal RBT is considered indirect evidence of the promising long-term oncologic safety of RNSM.…”

Section: Strengthsmentioning

confidence: 99%

Controversies and strengths of robot-assisted mastectomy

Kim

Toesca

Pozzi

et al. 2023

European Journal of Cancer Prevention

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Nipple-sparing mastectomy (NSM) is used to improve cosmetic outcomes while maintaining oncological safety in patients with early breast cancer; however, NSM requires a higher level of skill and workload than mastectomy and is associated with long, visible scars. Robotic surgical systems reduce surgeon workload and facilitate precise surgery. Considering the increasing support of robot-assisted NSM (RNSM), this paper aims to discuss the current controversies based on the research findings reported thus far. There are four concerns regarding RNSM; increased cost, oncological outcomes, the level of experience and skill, and standardization. It should be noted that RNSM is not a surgery performed on all patients but rather a procedure performed on selected patients who meet specific indications. A large-scale randomized clinical trial comparing robotic and conventional NSM has recently begun in Korea; therefore, it is necessary to wait for these results for more insight into oncological outcomes. Although the level of experience and skill required for robotic mastectomy may not be easily achieved by all surgeons, the learning curve for RNSM appears manageable and can be overcome with appropriate training and practice. Training programs and standardization efforts will help improve the overall quality of RNSM. There are some advantages to RNSM. The robotic system provides improved precision and accuracy, helping remove breast tissue more effectively. RNSM has advantages such as smaller scars, less blood loss, and a lower rate of surgical complications. Patients who undergo RNSM report better quality of life.

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Residual breast tissue after robot-assisted nipple sparing mastectomy

Cited by 14 publications

References 34 publications

Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery

Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery

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

Controversies and strengths of robot-assisted mastectomy

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