Practice of da Vinci robotic surgical system in mastectomy and immediate one-stage implant-based breast reconstruction_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Juliang ¹ , YANG Liu ¹ , ZHANG Mingkun ¹ , QIN Yuan ¹ , LI Xin ¹ , ZHANG Huan ¹ , DONG Jun ² , BAI Meng ² , ZHAO Ge ¹ ,  YAO Qing ¹ ,  LING Rui ¹

1. Department of Thyroid, Breast and Vascular Surgery, First Affiliated Hospital of The Air Force Military Medical University, Xi’an 710032, P. R. China;
2. Operating Department, First Affiliated Hospital of The Air Force Military Medical University, Xi’an 710032, P. R. China;

Corresponding author：

YAO Qing, Email: huanhuan@fmmu.edu.cn; LING Rui, Email: ling0105@163.com

Keywords：

breast cancer; da Vinci robotic surgical system; mastectomy; implant-based reconstruction

DOI：

10.7507/1007-9424.202209051

Video：

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Objective To investigate the clinical application of da Vinci surgical system in nipple sparing mastectomy (NSM) and immediate one-stage implant-based breast reconstruction. Methods Five cases of breast cancer who underwent NSM and immediate implant-based breast reconstruction were analyzed from March 2022 to April 2022. Evaluation endpoints included the key points of operation, duration of surgery, postoperative complications, and patient-reported outcomes. Results Two patients underwent implant-based postpectoral breast reconstruction without mesh. Three patients received prepectoral reconstruction with biological mesh, 2 of which underwent bilateral breast reconstruction. Operating duration of 5 patients was 240–320 min, with an average of 291 min. The blood loss was 10–30 mL, with an average of 18 mL. No patient switched to open surgery due to the uncontrolled bleeding. The average drainage volume was 78 mL/d (60–100 mL/d) in the first 3 days and 38 mL/d (30–50 mL/d) in the 3 to 7 days after operation. The drainage tube was removed 10–18 days after operation, with an average of 13.2 days. No postoperative infections or nipple-areolar complex necrosis were observed. The inpatient stay was 1–3 days, with an average of 1.8 days. One month after operation, the BREAST-Q satisfaction score was 64–82, with an average of 76.20. The average cost for operation was 45 072 RMB (43 420–47 524 RMB). Conclusions The robotic NSM and immediate one-stage implant-based breast reconstruction is a safe procedure with better clinical outcomes and favorable patients’ satisfaction. However, the robotic system has longer operation time and higher cost. It still needs to be personalized in the clinical practice.

Citation： ZHANG Juliang, YANG Liu, ZHANG Mingkun, QIN Yuan, LI Xin, ZHANG Huan, DONG Jun, BAI Meng, ZHAO Ge, YAO Qing, LING Rui. Practice of da Vinci robotic surgical system in mastectomy and immediate one-stage implant-based breast reconstruction. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(11): 1415-1420. doi: 10.7507/1007-9424.202209051 Copy

1.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
2.	Mathieu J, Daneau C, Lemeunier N, et al. Conservative interventions and clinical outcome measures used in the perioperative rehabilitation of breast cancer patients undergoing mastectomy: a scoping review. BMC Womens Health, 2022, 22(1): 343. doi: 10.1186/s12905-022-01927-3.
3.	Liu J, Guo D, Hunter S, et al. The uptake and factors associated with mastectomy among Chinese women with breast cancer: A retrospective observational study. Asian Pac J Cancer Prev, 2021, 22(5): 1599-1606.
4.	Lai HW, Chen ST, Liao CY, et al. Oncologic outcome of endoscopic assisted breast surgery compared with conventional approach in breast cancer: An analysis of 3 426 primary operable breast cancer patients from single institute with and without propensity score matching. Ann Surg Oncol, 2021, 28(12): 7368-7380.
5.	Lee HY, Chang YW, Yu DY, et al. Comparison of single incision endoscopic nipple-sparing mastectomy and conventional nipple-sparing mastectomy for breast cancer based on initial experience. J Breast Cancer, 2021, 24(2): 196-205.
6.	Zhang S, Xie Y, Liang F, et al. Video-assisted transaxillary nipple-sparing mastectomy and immediate implant-based breast reconstruction: A novel and promising method. Aesthetic Plast Surg, 2022, 46(1): 91-98.
7.	Zehra S, Doyle F, Barry M, et al. Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis. Breast Cancer, 2020, 27(4): 534-566.
8.	Cardoso F, Kyriakides S, Ohno S, et al. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2019, 30(8): 1194-1220.
9.	Karadsheh MJ, Tyrell R, Deng M, et al. Early postoperative outcomes in implant, pedicled, and free flap reconstruction for breast cancer: an analysis of 23, 834 patients from the ACS-NSQIP datasets. Breast Cancer Res Treat, 2021, 187(2): 525-533.
10.	Bailey CR, Ogbuagu O, Baltodano PA, et al. Quality-of-life outcomes improve with nipple-sparing mastectomy and breast reconstruction. Plast Reconstr Surg, 2017, 140(2): 219-226.
11.	Guo R, Li L, Su Y, et al. Current practice and barriers of mesh-assisted implant-based breast reconstruction in China: A nationwide cross-sectional survey of 110 hospitals. Eur J Surg Oncol, 2020, 46(1): 65-70.
12.	Blechman KM, Karp NS, Levovitz C, et al. The lateral inframammary fold incision for nipple-sparing mastectomy: outcomes from over 50 immediate implant-based breast reconstructions. Breast J, 2013, 19(1): 31-40.
13.	Cavalcante FP, Lima MVA. Nipple-sparing mastectomy with periareolar incision and two-stage reconstruction: Initial analysis of 31 cases. Breast J, 2018, 24(6): 940-943.
14.	Park S, Yoon C, Bae SJ, et al. Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction. Breast, 2020, 53: 85-91.
15.	Kuo YL, Chang CH, Chang TY, et al. Endoscopy-assisted total mastectomy with and without immediate reconstruction: An extended follow-up, multicenter study. Plast Reconstr Surg, 2021, 147(2): 267-278.
16.	Tang P, Hu Y, Wang ZH, et al. Clinical practice guidelines for endoscopic breast surgery in patients with early-stage breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021. Chin Med J (Engl), 2021, 134(21): 2532-2534.
17.	Lai HW, Chen ST, Lin YJ, et al. Minimal access (endoscopic and robotic) breast surgery in the surgical treatment of early breast cancer-trend and clinical outcome from a single-surgeon experience over 10 years. Front Oncol, 2021, 11: 739144. doi: 10.3389/fonc.2021.739144.
18.	Hancock KJ, Klimberg VS, Nunez-Lopez O, et al. Optimizing outcomes in colorectal surgery: cost and clinical analysis of robotic versus laparoscopic approaches to colon resection. J Robot Surg, 2022, 16(1): 107-112.
19.	Raffone A, Travaglino A, Raimondo D, et al. Laparotomic versus robotic surgery in elderly patients with endometrial cancer: A systematic review and meta-analysis. Int J Gynaecol Obstet, 2022, 157(1): 1-10.
20.	Ohsugi H, Akiyama K, Taniguchi H, et al. Tumor volume and tumor crossing of the axial renal midline predict renal function after robotic partial nephrectomy. Sci Rep, 2021, 11(1): 22526. doi: 10.1038/s41598-021-01539-1.
21.	Park HS, Lee J, Lai HW, et al. Surgical and oncologic outcomes of robotic and conventional nipple-sparing mastectomy with immediate reconstruction: International multicenter pooled data analysis. Ann Surg Oncol, 2022, 29(11): 6646-6657.
22.	李文涛, 陈海军, 司丕蕾, 等. 达芬奇机器人辅助下保留乳头乳晕的乳房切除并即刻假体乳房重建1例. 中华实用诊断与治疗杂志, 2021, 35(12): 1189-1190.
23.	Filipe MD, de Bock E, Postma EL, et al. Robotic nipple-sparing mastectomy complication rate compared to traditional nipple-sparing mastectomy: a systematic review and meta-analysis. J Robot Surg, 2022, 16(2): 265-272.
24.	Toesca A, Sangalli C, Maisonneuve P, et al. A randomized trial of robotic mastectomy versus open surgery in women with breast cancer or BrCA mutation. Ann Surg, 2022, 276(1): 11-19.
25.	Joo OY, Song SY, Lew DH, et al. Robotic harvest of a latissimus dorsi flap using a single-port surgical robotic system in breast reconstruction. Arch Plast Surg, 2021, 48(6): 577-582.

1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
2. Mathieu J, Daneau C, Lemeunier N, et al. Conservative interventions and clinical outcome measures used in the perioperative rehabilitation of breast cancer patients undergoing mastectomy: a scoping review. BMC Womens Health, 2022, 22(1): 343. doi: 10.1186/s12905-022-01927-3.
3. Liu J, Guo D, Hunter S, et al. The uptake and factors associated with mastectomy among Chinese women with breast cancer: A retrospective observational study. Asian Pac J Cancer Prev, 2021, 22(5): 1599-1606.
4. Lai HW, Chen ST, Liao CY, et al. Oncologic outcome of endoscopic assisted breast surgery compared with conventional approach in breast cancer: An analysis of 3 426 primary operable breast cancer patients from single institute with and without propensity score matching. Ann Surg Oncol, 2021, 28(12): 7368-7380.
5. Lee HY, Chang YW, Yu DY, et al. Comparison of single incision endoscopic nipple-sparing mastectomy and conventional nipple-sparing mastectomy for breast cancer based on initial experience. J Breast Cancer, 2021, 24(2): 196-205.
6. Zhang S, Xie Y, Liang F, et al. Video-assisted transaxillary nipple-sparing mastectomy and immediate implant-based breast reconstruction: A novel and promising method. Aesthetic Plast Surg, 2022, 46(1): 91-98.
7. Zehra S, Doyle F, Barry M, et al. Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis. Breast Cancer, 2020, 27(4): 534-566.
8. Cardoso F, Kyriakides S, Ohno S, et al. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2019, 30(8): 1194-1220.
9. Karadsheh MJ, Tyrell R, Deng M, et al. Early postoperative outcomes in implant, pedicled, and free flap reconstruction for breast cancer: an analysis of 23, 834 patients from the ACS-NSQIP datasets. Breast Cancer Res Treat, 2021, 187(2): 525-533.
10. Bailey CR, Ogbuagu O, Baltodano PA, et al. Quality-of-life outcomes improve with nipple-sparing mastectomy and breast reconstruction. Plast Reconstr Surg, 2017, 140(2): 219-226.
11. Guo R, Li L, Su Y, et al. Current practice and barriers of mesh-assisted implant-based breast reconstruction in China: A nationwide cross-sectional survey of 110 hospitals. Eur J Surg Oncol, 2020, 46(1): 65-70.
12. Blechman KM, Karp NS, Levovitz C, et al. The lateral inframammary fold incision for nipple-sparing mastectomy: outcomes from over 50 immediate implant-based breast reconstructions. Breast J, 2013, 19(1): 31-40.
13. Cavalcante FP, Lima MVA. Nipple-sparing mastectomy with periareolar incision and two-stage reconstruction: Initial analysis of 31 cases. Breast J, 2018, 24(6): 940-943.
14. Park S, Yoon C, Bae SJ, et al. Comparison of complications according to incision types in nipple-sparing mastectomy and immediate reconstruction. Breast, 2020, 53: 85-91.
15. Kuo YL, Chang CH, Chang TY, et al. Endoscopy-assisted total mastectomy with and without immediate reconstruction: An extended follow-up, multicenter study. Plast Reconstr Surg, 2021, 147(2): 267-278.
16. Tang P, Hu Y, Wang ZH, et al. Clinical practice guidelines for endoscopic breast surgery in patients with early-stage breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021. Chin Med J (Engl), 2021, 134(21): 2532-2534.
17. Lai HW, Chen ST, Lin YJ, et al. Minimal access (endoscopic and robotic) breast surgery in the surgical treatment of early breast cancer-trend and clinical outcome from a single-surgeon experience over 10 years. Front Oncol, 2021, 11: 739144. doi: 10.3389/fonc.2021.739144.
18. Hancock KJ, Klimberg VS, Nunez-Lopez O, et al. Optimizing outcomes in colorectal surgery: cost and clinical analysis of robotic versus laparoscopic approaches to colon resection. J Robot Surg, 2022, 16(1): 107-112.
19. Raffone A, Travaglino A, Raimondo D, et al. Laparotomic versus robotic surgery in elderly patients with endometrial cancer: A systematic review and meta-analysis. Int J Gynaecol Obstet, 2022, 157(1): 1-10.
20. Ohsugi H, Akiyama K, Taniguchi H, et al. Tumor volume and tumor crossing of the axial renal midline predict renal function after robotic partial nephrectomy. Sci Rep, 2021, 11(1): 22526. doi: 10.1038/s41598-021-01539-1.
21. Park HS, Lee J, Lai HW, et al. Surgical and oncologic outcomes of robotic and conventional nipple-sparing mastectomy with immediate reconstruction: International multicenter pooled data analysis. Ann Surg Oncol, 2022, 29(11): 6646-6657.
22. 李文涛, 陈海军, 司丕蕾, 等. 达芬奇机器人辅助下保留乳头乳晕的乳房切除并即刻假体乳房重建1例. 中华实用诊断与治疗杂志, 2021, 35(12): 1189-1190.
23. Filipe MD, de Bock E, Postma EL, et al. Robotic nipple-sparing mastectomy complication rate compared to traditional nipple-sparing mastectomy: a systematic review and meta-analysis. J Robot Surg, 2022, 16(2): 265-272.
24. Toesca A, Sangalli C, Maisonneuve P, et al. A randomized trial of robotic mastectomy versus open surgery in women with breast cancer or BrCA mutation. Ann Surg, 2022, 276(1): 11-19.
25. Joo OY, Song SY, Lew DH, et al. Robotic harvest of a latissimus dorsi flap using a single-port surgical robotic system in breast reconstruction. Arch Plast Surg, 2021, 48(6): 577-582.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Practice of da Vinci robotic surgical system in mastectomy and immediate one-stage implant-based breast reconstruction

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