Ideas and potential benefits of single-port robotic mastectomy and reconstruction

Abstract

Robotic approaches are gaining popularity in various fields of surgery.Their application to breasts was not widespread worldwide until now, compared to other surgeries since their introduction by Toesca in 2017 (1).Now, some European and Asian surgeons conduct robotic mastectomy and reconstruction and have reported acceptable outcomes in a few literatures.As a breast reconstructive surgeon who has experienced over 200 cases of robotic mastectomy, I agree with the report of Farr et al. in most aspects but have somewhat different opinions on a few points (2).For the robot device, DaVinci Xi or Si was used in early robotic breast surgeries.It was feasible, but a little bit inappropriate considering the small breast pocket and the possibility of collision by multiple arms during mastectomy.After the introduction of DaVinci SP, due to its lesser space occupying nature, flexible three-dimensional camera, and need of just a short incision, it became the dominant robotic system in robotic breast surgeries in our institute.Those authors described robotic breast surgery as being safely performed by experienced surgeons with limited previous robotic training, however, in our experience, the running curve may be different from surgeon to surgeon.We believe that the key factor in a successful outcome in robot mastectomy is the maintenance of blood perfusion to the mastectomy flap.