Study of heat steam induced skin damage prevention in robotic nipple-sparing mastectomy and immediate breast reconstruction using Da Vinci Robot_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Kuo ,  LÜ Pengwei

Department of Breast Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P. R. China;

Corresponding author：

LÜ Pengwei, Email: lvpengwei1983@hotmail.com

Keywords：

Robotic surgery; breast reconstruction; skin; heat damage

DOI：

10.7507/1002-1892.202404067

Video：

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Objective To explore the method of preventing heat steam induced skin damage in robotic nipple-sparing mastectomy and immediate breast reconstruction (R-NSM-IBR) using Da Vinci Robots. Methods A clinical data of 128 female patients with breast cancer, who were treated with R-NSM-IBR between September 2022 and December 2023 and met the selection criteria, was retrospectively analyzed. During robotic nipple-sparing mastectomy, the breasts were covered with gauze cooled by ice water to reduce skin temperature in 99 cases (group A) and were not treated in 29 cases (group B). There was no significant difference in the age, affected side, body mass index, pathological type of breast cancer, and constituent ratios of adjuvant chemotherapy and neoadjuvant chemotherapy between the two groups (P>0.05). Intraoperative breast skin temperature, unilateral robotic nipple-sparing mastectomy time, and the incidence of complications of breast heat steam induced skin damage were recorded. Results The time for unilateral robotic nipple-sparing mastectomy was (77.18±9.23) minutes in group A and (76.38±12.88) minutes in group B, with significant difference between the two groups (P<0.05). The intraoperative breast skin temperature was significantly lower in group A than in group B [(25.61±0.91)℃ vs (33.38±1.14)℃; P<0.05]. Seven cases of heat steam skin damage occurred during operation, including 2 cases (2.0%) in group A and 5 cases (17.2%) in group B, with a significant difference in incidence between the two groups (P<0.05). Among them, 1 patient in group B had a vesication rupture and infection, which eventually led to the removal of the implant; the rest of the patients were treated with postoperative interventions for skin recovery. Conclusion The use of breast covered with gauze cooled by ice water during R-NSM-IBR can effectively reduce the risk of heat steam induced skin damage.

Citation： CHEN Kuo, LÜ Pengwei. Study of heat steam induced skin damage prevention in robotic nipple-sparing mastectomy and immediate breast reconstruction using Da Vinci Robot. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(7): 813-817. doi: 10.7507/1002-1892.202404067 Copy

1.	朱振中, 郑国焱, 张长青. 机器人辅助技术在创伤骨科的发展与临床应用. 中国修复重建外科杂志, 2022, 36(8): 915-922.
2.	Toesca A, Peradze N, Galimberti V, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with implant: first report of surgical technique. Ann Surg, 2017, 266(2): e28-e30.
3.	Chen K, M Beeraka N, Zhang J, et al. Efficacy of da Vinci robot-assisted lymph node surgery than conventional axillary lymph node dissection in breast cancer—A comparative study. Int J Med Robot, 2021, 17(6): e2307. doi: 10.1002/rcs.2307.
4.	Chen K, Zhang J, Beeraka NM, et al. Robot-assisted minimally invasive breast surgery: recent evidence with comparative clinical outcomes. J Clin Med, 2022, 11(7): 1827. doi: 10.3390/jcm11071827.
5.	刘馨然, 谢妍妍, 梁法清, 等. 腋窝入路腔镜下乳腺癌根治假体结合补片在一期乳房重建中的应用. 中国修复重建外科杂志, 2021, 35(9): 1212-1214.
6.	Qiu M, Yang H, Zhou J, et al. Short-term safety and cosmetic outcomes of endoscopic direct-to-implant breast reconstruction and simultaneous contralateral breast augmentation for breast cancer: a prospective analysis of 33 patients. World J Surg Oncol, 2023, 21(1): 201. doi: 10.1186/s12957-023-03089-4.
7.	Chen K, Zhang J, Beeraka NM, et al. Robot-assisted nipple-sparing mastectomy and immediate breast reconstruction with gel implant and latissimus dorsi muscle flap: Our initial experience. Int J Med Robot, 2023, 19(5): e2528. doi: 10.1002/rcs.2528.
8.	Ahn JH, Park JM, Choi SB, et al. Early experience of robotic axillary lymph node dissection in patients with node-positive breast cancer. Breast Cancer Res Treat, 2023, 198(3): 405-412.
9.	Park HS, Lee J, Lee DW, et al. Robot-assisted nipple-sparing mastectomy with immediate breast reconstruction: an initial experience. Sci Rep, 2019, 9(1): 15669. doi: 10.1038/s41598-019-51744-2.
10.	Lee H, Lee J, Lee K, et al. Comparison between gasless and gas-inflated robot-assisted nipple-sparing mastectomy. J Breast Cancer, 2021, 24(2): 183-195.
11.	Cheong JY, Keshava A, Witting P, et al. Effects of intraoperative insufflation with warmed, humidified CO₂ during abdominal surgery: a review. Ann Coloproctol, 2018, 34(3): 125-137.
12.	Sharma S, McKechnie T, Khamar J, et al. The role of warmed-humidified carbon dioxide insufflation in colorectal surgery: A systematic review and meta-analysis. Colorectal Dis, 2024, 26(1): 7-21.
13.	Klugsberger B, Schreiner M, Rothe A, et al. Warmed, humidified carbon dioxide insufflation versus standard carbon dioxide in laparoscopic cholecystectomy: a double-blinded randomized controlled trial. Surg Endosc, 2014, 28(9): 2656-2660.
14.	Tong MM, Xu XJ, Bao XH. Clinical effects of warmed humidified carbon dioxide insufflation in infants undergoing major laparoscopic surgery. Medicine (Baltimore), 2019, 8(27): e16151. doi: 10.1097/MD.0000000000016151.
15.	Gunusen I, Akdemir A, Sargın A, et al. The effects of CO₂ pneumoperitoneum at different temperature and humidity on hemodynamic and respiratory parameters and postoperative pain in gynecological laparoscopic surgery: A prospective randomized controlled study. Asian J Surg, 2022, 45(1): 154-161.
16.	Balayssac D, Selvy M, Martelin A, et al. Clinical and organizational impact of the Airseal^® insufflation system during laparoscopic surgery: a systematic review. World J Surg, 2021, 45(3): 705-718.
17.	Cooper J, Joseph C, Zagrodzky J, et al. Active esophageal cooling during radiofrequency ablation of the left atrium: data review and update. Expert Rev Med Devices, 2022, 19(12): 949-957.
18.	Nakata Y, Haji S, Ishikawa H, et al. Two cases of hepatocellular carcinoma located adjacent to the Glisson’s capsule treated by laparoscopic radiofrequency ablation with intraductal chilled saline perfusion through an endoscopic nasobiliary drainage tube. Surg Laparosc Endosc Percutan Tech, 2010, 20(6): e189-e192.

1. 朱振中, 郑国焱, 张长青. 机器人辅助技术在创伤骨科的发展与临床应用. 中国修复重建外科杂志, 2022, 36(8): 915-922.
2. Toesca A, Peradze N, Galimberti V, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with implant: first report of surgical technique. Ann Surg, 2017, 266(2): e28-e30.
3. Chen K, M Beeraka N, Zhang J, et al. Efficacy of da Vinci robot-assisted lymph node surgery than conventional axillary lymph node dissection in breast cancer—A comparative study. Int J Med Robot, 2021, 17(6): e2307. doi: 10.1002/rcs.2307.
4. Chen K, Zhang J, Beeraka NM, et al. Robot-assisted minimally invasive breast surgery: recent evidence with comparative clinical outcomes. J Clin Med, 2022, 11(7): 1827. doi: 10.3390/jcm11071827.
5. 刘馨然, 谢妍妍, 梁法清, 等. 腋窝入路腔镜下乳腺癌根治假体结合补片在一期乳房重建中的应用. 中国修复重建外科杂志, 2021, 35(9): 1212-1214.
6. Qiu M, Yang H, Zhou J, et al. Short-term safety and cosmetic outcomes of endoscopic direct-to-implant breast reconstruction and simultaneous contralateral breast augmentation for breast cancer: a prospective analysis of 33 patients. World J Surg Oncol, 2023, 21(1): 201. doi: 10.1186/s12957-023-03089-4.
7. Chen K, Zhang J, Beeraka NM, et al. Robot-assisted nipple-sparing mastectomy and immediate breast reconstruction with gel implant and latissimus dorsi muscle flap: Our initial experience. Int J Med Robot, 2023, 19(5): e2528. doi: 10.1002/rcs.2528.
8. Ahn JH, Park JM, Choi SB, et al. Early experience of robotic axillary lymph node dissection in patients with node-positive breast cancer. Breast Cancer Res Treat, 2023, 198(3): 405-412.
9. Park HS, Lee J, Lee DW, et al. Robot-assisted nipple-sparing mastectomy with immediate breast reconstruction: an initial experience. Sci Rep, 2019, 9(1): 15669. doi: 10.1038/s41598-019-51744-2.
10. Lee H, Lee J, Lee K, et al. Comparison between gasless and gas-inflated robot-assisted nipple-sparing mastectomy. J Breast Cancer, 2021, 24(2): 183-195.
11. Cheong JY, Keshava A, Witting P, et al. Effects of intraoperative insufflation with warmed, humidified CO₂ during abdominal surgery: a review. Ann Coloproctol, 2018, 34(3): 125-137.
12. Sharma S, McKechnie T, Khamar J, et al. The role of warmed-humidified carbon dioxide insufflation in colorectal surgery: A systematic review and meta-analysis. Colorectal Dis, 2024, 26(1): 7-21.
13. Klugsberger B, Schreiner M, Rothe A, et al. Warmed, humidified carbon dioxide insufflation versus standard carbon dioxide in laparoscopic cholecystectomy: a double-blinded randomized controlled trial. Surg Endosc, 2014, 28(9): 2656-2660.
14. Tong MM, Xu XJ, Bao XH. Clinical effects of warmed humidified carbon dioxide insufflation in infants undergoing major laparoscopic surgery. Medicine (Baltimore), 2019, 8(27): e16151. doi: 10.1097/MD.0000000000016151.
15. Gunusen I, Akdemir A, Sargın A, et al. The effects of CO₂ pneumoperitoneum at different temperature and humidity on hemodynamic and respiratory parameters and postoperative pain in gynecological laparoscopic surgery: A prospective randomized controlled study. Asian J Surg, 2022, 45(1): 154-161.
16. Balayssac D, Selvy M, Martelin A, et al. Clinical and organizational impact of the Airseal^® insufflation system during laparoscopic surgery: a systematic review. World J Surg, 2021, 45(3): 705-718.
17. Cooper J, Joseph C, Zagrodzky J, et al. Active esophageal cooling during radiofrequency ablation of the left atrium: data review and update. Expert Rev Med Devices, 2022, 19(12): 949-957.
18. Nakata Y, Haji S, Ishikawa H, et al. Two cases of hepatocellular carcinoma located adjacent to the Glisson’s capsule treated by laparoscopic radiofrequency ablation with intraductal chilled saline perfusion through an endoscopic nasobiliary drainage tube. Surg Laparosc Endosc Percutan Tech, 2010, 20(6): e189-e192.

Chinese Journal of Reparative and Reconstructive Surgery

Study of heat steam induced skin damage prevention in robotic nipple-sparing mastectomy and immediate breast reconstruction using Da Vinci Robot

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