Single-port robot-assisted prosthetic breast reconstruction with the da Vinci SP Surgical System: first clinical report

Abstract

Robot-assisted nipple-sparing mastectomy with immediate reconstruction is currently performed in an attempt to seek smaller and indistinct incisions. Robotic surgery system has been evolving under the concept of minimal invasive technique which is a recent trend in surgery. One of the latest version is the da Vinci SP Surgical System (Intuitive Surgical). In this report, we will share our experiences. Two patients underwent robot-assisted nipple-sparing mastectomy, each followed by immediate robot-assisted expander insertion and prepectoral direct-to-implant breast reconstruction, respectively. There was no open conversion or major postoperative complication. One patient experienced mild infection, which was resolved by intravenous antibiotic treatment. Simple docking process, multi-joint instruments, and third-arm functionality are among the new surgical system’s advantages. The present cases suggest that robot-assisted nipple-sparing mastectomy with immediate reconstruction using the da Vinci SP Surgical System is feasible and safe. The promising features and potential application of da Vinci SP in breast reconstruction need further study.

Single-Port Transaxillary Robot-Assisted Latissimus Dorsi Muscle Flap Reconstruction for Poland Syndrome: Concomitant Application of Robotic System to Contralateral Augmentation Mammoplasty

“…6 10 Joo et al performed prosthetic breast reconstruction through an incision of 2.5 to 4.7 cm using the da Vinci SP system with a gasless technique. 11 In our study, RLDF surgery was performed through a 5-cm incision in the midaxillary crease and augmentation mammoplasty was performed through a 3-cm incision in the axillary crease with gas inflation. With the da Vinci SP system, the prognosis of postoperative skin necrosis or scarring is superior because not only is the length and number of the incision reduced, but also the damage to the incision skin flap from the retractor is significantly reduced.…”

Robotics in Implant-Based and Autologous Breast Reconstruction

“…Under direct vision, 6-mm bipolar forceps and a monopolar cautery spatula are used to elevate the pectoralis major muscle from its lateral to the level of the nipple, proceeding inferomedially until an adequate submuscular pocket is created. 23 If desired, ADM can then be sutured to the inferior border of the pectoralis major superiorly and the inframammary fold (IMF) inferiorly with interrupted sutures, leaving space for lateral insertion of an implant. After irrigation with antibiotic saline, the implant is typically placed using a no-touch method, followed by manual closure of the ADM pocket and skin.…”

“…After irrigation with antibiotic saline, the implant is typically placed using a no-touch method, followed by manual closure of the ADM pocket and skin. 19,23 Jeon et al used robotic assistance to reduce the palpable implant edge and upper pole rippling seen in subglandular reconstruction. 7 This modified submuscular technique, the anterior tenting method, involves dividing the pectoralis major muscle near the planned upper border of the implant, elevating the superior portion of the pectoralis major, suturing ADM to the superior muscle flap proceeding medially, then suturing the ADM sling to the superficial surface of the pectoralis major toward the IMF, leaving a space for manual insertion of the implant laterally.…”

Robot-assisted surgeries in oral and maxillofacial area: a narrative review on the present, advantages and its future

“…Da Vinci, which remains the most recent surgical system, has now undergone several developments. The Da Vinci single-port (SP) platform enables a less invasive approach than multiple ports (13).…”