Robotic breast and reconstructive surgery: 100 procedures in 2-years for 80 patients

To analyze results of the first 100 robotic breast surgeries: feasibility, morbidity, indications and standardization of patient positioning and operative technique.

Robotic breast surgery is an emergent procedure.

A prospective cohort of patients undergoing robotic latissimus dorsi-flap reconstruction (RLDFR) and or robotic mastectomy, over a period of 24 months was analyzed. We analyzed patient's characteristics, previous treatment for breast cancer, primitive breast cancer or local recurrence, immediate or delayed breast reconstruction and type of reconstruction. Surgical techniques and duration of surgery were reported according to three successive periods.

46.2% of patients (37/80) had previous breast radiotherapy and 26.2% (21/80) had received neo-adjuvant chemotherapy. Surgical procedure and patient position are described. Surgical incision used for RLDFR was: 37 axillar (50.7%), 20 (27.4%) areolar, 7 (9.6%) central breast, 10 (13.7%) previous incision. Number of surgical procedures was >2 for 35 patients. In logistic regression, factors significantly associated with duration of surgery ≥305mn were: P2 with decreased operative duration (OR: 0.077, p = 0.002) and P3 (OR: 0.015, p < 0.0001) versus P1; and number of surgical procedures: 4 surgical procedures (OR: 15.60, p = 0.048) versus 1. Median hospital stay was 4 days. Total complication rate was 57.5% (46 patients) with 6 grade 2, 9 grade 3 and 1 grade 4 complication. For RLDFR we reported 1 grade 3 (1.3%) and 29 grade 1 (39.7%) complications consisting in dorsal seromas.

RLDFR is a safe and reproducible procedure that allows breast reconstruction through a single incision, without dorsal scar. A decrease in surgery duration was observed with technique standardization and throughout the learning curve.