Robotic nipple sparing mastectomy and immediate breast reconstruction with robotic latissimus dorsi flap harvest – Technique and preliminary results

Lai, Hung-Wen; Lin, Shih-Lung; Chen, Shou‐Tung; Lin, Ya-Ling; Chen, Dar‐Ren; Pai, Shu-Shin; Kuo, Shou‐Jen

doi:10.1016/j.bjps.2018.07.006

Cited by 31 publications

(45 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Subsequently, few additional publications have described the use of RNSM ( Table 3 ) [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ]. Reported complications include nipple areolar complex necrosis, mastectomy flap necrosis, temporary skin blistering, hematoma, seroma, infection, loss of implant from infection, delayed axillary wound healing, transient brachial plexus neurapraxia (due to arm positioning), transient common peronal nerve neurapraxia (due to patient positioning during surgery).…”

Section: Discussionmentioning

confidence: 99%

“…Total mammary glandular excision in NSM can be technically challenging, due to small size of the incision and poor visualization of the dissection plane. To help overcome the challenges in open NSM, use of the robot (da Vinci Surgical System, Intuitive Surgical, Sunnyvale, CA) for robot-assisted nipple sparing mastectomy (RNSM) is an emerging operation [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Residual breast tissue after robot-assisted nipple sparing mastectomy

et al. 2021

View full text Add to dashboard Cite

Introduction: While the long-term oncologic safety of robot-assisted nipple sparing mastectomy (RNSM) remains to be elucidated, histologically detected residual breast tissue (RBT) can be a surrogate for oncologically sound mastectomy. The objective of this study is to determine the presence of RBT after RNSM. Methods: Between August 2019eJanuary 2020, we completed 5 cadaveric RNSMs. Full thickness biopsies from the mastectomy skin flap were obtained from predefined locations radially around the mastectomy skin envelop and nipple areolar complex to histologically evaluate for RBT. Results: The first case was not technically feasible due to inability to obtain adequate insufflation. Five mastectomy flaps were analyzable. The average mastectomy flap thickness was 2.3 mm (range 2e3 mm) and the average specimen weight was 382.72 g (range 146.9e558.3 g). Of 70 total biopsies, RBT was detected in 11 (15.7%) biopsies. Most common location for RBT was in the nipple-areolar complex, with no RBT detected from the peripheral skin flaps. Conclusions: In this cadaveric study, RNSM is feasible leaving minimal RBT on the mastectomy flap. The most common location for RBT is in the periareolar location consistent with previous published findings after open NSM. Clinical studies are underway to evaluate the safety of RNSM.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Residual breast tissue after robot-assisted nipple sparing mastectomy

et al. 2021

View full text Add to dashboard Cite

show abstract

“…R-NSM was reported in some studies 11-14 including 74 prophylactic mastectomies (8 prophylactic NSM for 6 patients, 14 63 prophylactic NSM for 33 patients, 13 2 patients, 15 2 prophylactic NSM, 11 ) and 47 therapeutic mastectomies (21 NSM for 18 patients with BC, 14 2 BC, 32 22 patients with 23 NSM for BC, 15 1 patient for ductal carcinoma in situ [DCIS] 13 ). NSM for BC can be proposed for patients without NACx involvement or with a tumor NACx distance ≥2 cm.…”

Section: Discussionmentioning

confidence: 99%

“…Only 2 cases of R-NSM with RLDFR were reported. 32 The purpose of this study was to report our experience of this combined robotic procedure and to describe the techniques used, indications, and reproducibility.…”

Section: Introductionmentioning

confidence: 99%

Robotic Nipple-Sparing Mastectomy and Immediate Breast Reconstruction With Robotic Latissimus Dorsi Flap Harvest: Technique and Results

et al. 2020

View full text Add to dashboard Cite

Introduction. Only few cases of robotic latissimus dorsi flap reconstruction (RLDFR) have been reported in indication of reconstruction for breast cancer (BC). We report our experience of combined robotic nipple-sparing mastectomy (R-NSM) and RLDFR, and analyze technique, indications, and reproducibility. Methods. All patients with R-NSM and RLDFR from November 2016 to August 2, 2018, were analyzed, and technics have been described. Complication rate with Clavien-Dindo grading and postoperative hospitalization length (days) are reported. Results. Thirty-five R-NSM with RLDFR were performed in 22 cases for primitive BC and 13 for local recurrence. In 12 patients, another surgical procedure was performed during the same time (axillary lymph node dissection or contralateral breast surgery). R-NSM was realized through a short axillar incision, with inside-only installation for 12 patients (34.3%): 18 nonautologous and 17 autologous RLDFR associated with implant in 9 patients. In logistic regression, mastectomy weight >330 g was significantly associated with the use of implant (odds ratio [OR] = 17, P = .015), and significant factor of the time of anesthesia ≥380 minutes was 2 installations (OR = 10.4, P = .049). The median duration of hospitalization stay was 4 days. Complications rates were 51.4% (18/35; 9 grade-1, 2 grade-2, and 7 grade-3). In logistic regression, associated other surgical procedure was predictive of grade-3 complications (OR = 6.87, P = .053). Conclusion. We confirmed the reproducibility and safety of R-NSM and RLDFR with a decreased complication rate. NSM was performed in 42.8% of our patients after previous radiotherapy. We observed an increase of grade-3 complications when R-NSM and RLDFR was combined to another surgical procedure.

show abstract

“…Our second and third RLDFH operation times were 97 minutes and 90 minutes, respectively. [ 28 ] This quick drop in operation time was related to the 3-dimensional vision, flexibility of instruments, and friendly operating system of the da Vinci surgical platform.…”

Section: Discussionmentioning

confidence: 99%

Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer

et al. 2018

Self Cite

View full text Add to dashboard Cite

Rationale:The clinical application of robotic surgery in breast conserving surgery or volume replacement with robotic latissimus dorsi flap harvest (RLDFH) has been rarely reported. In this study, we report the preliminary experience and clinical outcome of robotic assisted quadrantectomy (RAQ) and immediate partial breast reconstruction (IPBR) with RLDFH.Patient concern:Decreasing and avoid back scar length after latissimus dorsi flap harvest.Diagnoses:One 28 years old female with left breast cancer underwent RAQ and IPBR with RLDFH. Initially, she was diagnosed with left breast infiltrating carcinoma that was clinical stage T3N1M0 and triple negative.Interventions:Neoadjuvant chemotherapy consisting of 4 cycles of epirubicin and cyclophosphamide followed by 4 cycles of docetaxel was performed. Breast magnetic resonance imaging showed residual breast cancer about 4.5 cm over the left upper outer quadrant of the breast. Sentinel lymph node biopsy showed no lymph node metastasis. RAQ, which took 82 minutes, was performed first, and the resected breast specimen's weight was 203 gm. She received IPBR with RLDFH, which took 97 minutes.Outcomes:The overall blood loss was 40 mL. The final pathology result was ypT2 (4.2 cm)N0 (sn0/3)M0 and stage IIA. The resection margin was free of tumors. The post-operative recovery was smooth except for seroma formation over the back, which was relieved after repeated aspiration at an outpatient clinic. The patient was satisfied with the post-operative scar and aesthetic outcome. No local recurrence, distant metastasis or case mortality was found during 5 months of follow-up.Lessons:RAQ and IPBR with RLDFH is a safe alternative for small-to-medium-breast-size women with breast cancer who desire breast conservation and are indicated for volume replacement with autologous latissimus dorsi flap.

show abstract

Robotic nipple sparing mastectomy and immediate breast reconstruction with robotic latissimus dorsi flap harvest – Technique and preliminary results

Cited by 31 publications

References 4 publications

Residual breast tissue after robot-assisted nipple sparing mastectomy

Residual breast tissue after robot-assisted nipple sparing mastectomy

Robotic Nipple-Sparing Mastectomy and Immediate Breast Reconstruction With Robotic Latissimus Dorsi Flap Harvest: Technique and Results

Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer

Contact Info

Product

Resources

About