Robotic Breast Surgery: History and Future

In 2015, a group of surgeons in Milan, Italy demonstrated the feasibility and safety of robotic nipple-sparing mastectomy and robotic breast reconstruction. The Italian surgeons published their results in their first 29 consecutive patients. In this report, all patients had robotic mastectomy and reconstruction done through a 3 cm extra-mammary incision, hidden by the arm. The results of the initial experience were impressive. No major complications were noted. Thereafter, a surgeon in Paris began performing robotic mastectomy and breast reconstruction. Given the impressive results, Dr. Neil Tanna decided to bring the operation to the United States. He traveled to Italy and France to collaborate with the surgeons there. On March 4, 2018, Dr. Neil Tanna and colleagues performed the first robotic nipple-sparing mastectomy and robotic breast reconstruction in North America.

Robot Breast Surgery

Innovative Technique with Superior Results

Robotic breast surgery involves using the robot to perform nipple-sparing mastectomy and breast reconstruction. Traditional (open) nipple-sparing mastectomy and breast reconstruction require incisions on the breast. Robotic nipple sparing mastectomy with robotic breast reconstruction is an innovative form of breast surgery that utilizes robotic technology to perform the surgery. By using the robot, the incisions can be much smaller and be placed off the breasts, far away near the armpit or the bra line.

Robotic nipple sparing mastectomy with robotic breast reconstruction is an innovative and advanced technique, intended to improve aesthetic results, patient satisfaction, minimize invasiveness, and overcome the technical limitations experienced with the traditional open technique. By using the robot, the surgeon can overcome problems associated with the traditional manual technique such as limited internal mobility, inconsistent views of the surgical site, and poor dissection angles, which makes it difficult to reach certain areas. Instead, robotic breast surgery is performed through a small incision, located away and off the breast. The robotic system enables the surgeon to remove the breast tissue with precision and accuracy and perform simultaneous breast reconstruction. This allows for full preservation of the breast skin and nipple areola complex, without any visible scar on the breast tissue.

Small incisions: aesthetic and safe

As with any surgery, there are risks of developing complications. Robotic nipple sparing mastectomy and robotic breast reconstruction utilizes the da Vinci robotic Xi surgical system to provide superior clinical outcomes. Traditional nipple sparing mastectomy is a difficult technique to perform because of the technical limitations associated with the procedure.

The blood supply to the nipple areola complex and the breast skin envelope is through the skin. Incisions placed on the breast can decrease this blood supply. By placing incisions near the armpit, away from the breast, blood supply is preserved to the breast skin and the nipple. This may reduce the risk of loss of the skin and/or nipple (tissue necrosis).

Keeping a small incision off the breast may also help reduce infection and pain. Infections following nipple-sparing mastectomy with implant based breast reconstruction can be devastating. It can result in the need for antibiotics or, even in some cases, necessitate removal of the implant. The robotic nipple sparing mastectomy approach using the da Vinci surgical system may reduce the risk of infection during surgery. Since the length of the incision is small and away from the breast, the surgery is less invasive and patients are less susceptible to bacterial infection as less tissue is exposed to the environment.

The precision of the machine minimizes the size of the incision, which reduces the risk of scar tissue related complications. The smaller incision site may also heal much faster than the larger incision site in traditional nipple sparing mastectomy. This should lead to less pain and faster recovery after surgery. The small incision has the potential to translate to optimal aesthetics, higher patient satisfaction, less pain, and quicker recovery.

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