Consensus Statement on Robotic Mastectomy—Expert Panel From International Endoscopic and Robotic Breast Surgery Symposium (IERBS) 2019

Abstract

Objectives: To achieve a consensus statement on robotic mastectomy. Background: Robotic-assisted surgery has gained much attention especially the results of few case series reporting on the technical feasibility, safety and early oncologic outcomes of robotic-assisted mastectomy in a few centers worldwide. The aim of this consensus statement was to develop and provide standardized guidelines on robotic mastectomy based on consensus statement by a panel of experts from indications to outcome measures and indicators, thereby providing a valuable guide for breast surgeons worldwide. Methodology: An internationally representative expert panel of 10 surgeons was invited to participate in the generation of a consensus statement. 52 statements were created in 6 domains: indications, contraindications, technical considerations, patient counseling, outcome measures and indicators, training and learning curve assessment. Experts were asked to vote if they agree, disagree or of the opinion that the statement should be rephrased. Two electronic rounds via online survey of iterative rating and feedback were anonymously completed, followed by a final round of in-person meeting during the inaugural International Endoscopic and Robotic Breast Surgery Symposium 2019 from May 24 to 25, 2019. Consensus was reached when there was at least 80% agreement on each statement. Results: A total of 53 statements with at least 80% agreement were generated after 3 rounds of voting; 21 statements from first round of voting, 20 statements from second round of voting and 12 statements from the final round of in-person meeting. All experts agreed that the consensus statement served as expert recommendations but not mandatory for a successful and safe practice of robotic mastectomy. Conclusion: Robotic mastectomy is a promising technique and could well be the future of minimally invasive breast surgery whereas proving to be safe and feasible. The first consensus statement on robotic mastectomy from an international panel of experts serves as an extremely important milestone and provides recommendations for breast surgeons keen to embark on this technique.

Robotic Versus Conventional Nipple-Sparing Mastectomy With Immediate Breast Reconstruction

“…After the preliminary experience of R-NSM with 27 R-NSM ( 27 ), we determined a standardized technique with dissection with non-robotic scissors after sub cutaneous infiltration with adrenaline serum and then robotic dissection through a mono-trocar insert in axillary or lateral small incision ( 26 , 27 ). This technique was reported as the consensus ( 28 ). In this prospective study, we analyzed patients operated on between March 2018 and March 2020, with and without robotic assistance (R-NSM and C-NSM) and IBR with implant breast or latissimus dorsiflap (LDF) with or without association with implant.…”

“…Several studies reported a few cases of robotic-NSM (R-NSM) to evaluate feasibility, reproducibility, and safety (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Recently, a technical robotic surgical consensual NSM procedure was reported (28). However, comparison between R-NSM and conventional-NSM (C-NSM) has been recently reported in only one retrospective study with a small sample size and for procedures realized by only one surgeon (29).…”

The modern approach to the nipple‐sparing mastectomy

“…Mayo reported their results with NSM over the last decade, showing a decrease in complication rate even with the broadening of indications for the procedure to higher‐risk patients; this confirms a team learning curve for the procedure 60 . Interestingly, the robotic approach to NSM, which was only first reported within the last 3 years, already has several published manuscripts regarding the learning curve 44,61‐63 …”

Mastectomy with immediate breast reconstruction: Results of a mono-centric 4-years cohort

“…Endoscopic procedure is an emerging technique that has not yet been fully validated. This allows a NSM with a unique axillary approach with endoscopic or robotic technic, which is now well determined [ 65 ] but contribution of these procedures in comparison with traditional-NSM must be confirmed by prospective studies with analysis of complication rates, aesthetics advantages and cost efficiency. All recent studies about R-NSM showed that this technic could be performed with a brief learning curve [ [14] , [15] , [16] , [17] , [65] , [66] , [67] ].…”