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William J. Gradishar, MD, FACP, FASCO
William J. Gradishar, MD, FACP, FASCO
Posted: Friday, February 16, 2024
Nipple-sparing mastectomy may be accomplished safely and reliably with the single-port da Vinci SP robotic system, according to Deborah E. Farr, MD, of The University of Texas Southwestern Medical Center, Dallas, and colleagues. In fact, a surgeon with limited robotic experience successfully completed 20 bilateral mastectomies using this system, with 65% of patients experiencing nipple-areolar complex sensation after surgery. The findings of this case series were published in JAMA Surgery.
“Although robotic nipple-sparing mastectomy has demonstrated acceptable long-term oncologic outcomes and safety profile, the use of the single-port robotic system has not gained widespread applicability due to concerns over surgeon learning curve, the lack of uniformity in postresection breast reconstruction, and absence of patient-reported outcomes following resection and reconstruction,” stated the study investigators. “In this study, the single-port da Vinci SP was appropriate for the procedure.”
Patients with breast cancer or a high risk of breast cancer (20% or higher lifetime risk) underwent bilateral single-port robotic nipple-sparing mastectomy and immediate reconstruction with prepectoral implants (n = 20). Absence of residual invasive or in situ breast and axillary tissue was considered evidence of pathologic complete response. Breast size ranged from A through D cup, with a median cup size of B. Body mass index ranged from 19.7 kg/m2 through 27.8 kg/m2, with a median of 24.4 kg/m2.
The median robotic time for bilateral surgery was 116 minutes and varied across cup size, at 95, 140, 118, and 114 minutes for A through D cups, respectively. Median operative time was 277 minutes. After surgery, 95% of skin sensation and 55% of nipple sensation were preserved. For the first 10 patients, 20 resected breasts had measurable nipple sensation (range, 4–36 months). For the remaining patients, nipple sensation was preserved in 13 of 20 resected breasts 2 weeks after surgery. No immediate operative or oncologic complications such as hematoma, positive margins, or recurrence were observed.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
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