The first multicenter study of robot-assisted breast-conserving surgery: insights from the KoREa-BSG group

Robot-assisted breast-conserving surgery has a potentially better cosmetic benefit than conventional breast-conserving surgery without any scarring on the breast. However, data on the feasibility and safety are limited. This study presents the results of early robot-assisted breast-conserving surgery.

A multi-center retrospective review was conducted to identify women who underwent robot-assisted breast- conserving surgery between August 2019 and October 2023. Information on the clinicopathological characteristics, perioperative complications, operation time, recurrence, and reoperation was collected.

A total of 150 patients underwent the surgery performed by ten breast surgeons at seven institutions. Invasive breast cancer was observed in 121 cases and ductal carcinoma in situ was detected in 29 cases. Of all the patients, 75.3% and 65.3% had an estrogen and progesterone receptor positive status, respectively. A total of 35.3% of the patients had a HER2-positive status. In terms of the surgical technique, the Da Vinci SP system was more frequently used (60%). Gas insufflation was applied in 97.33% of the cases, and sentinel lymph node biopsy was the most common axillary surgery (89.3%). The median postoperative days was 5.4 days. The incision location was the mid-axillary line, and the median incision length was 37.1 mm. The median total operation time was 133.8 min. Eleven cases (7.3%) had positive frozen margins, and only one case (0.7%) required reoperation because of permanent positive margin. Six patients (4%) developed surgical complications. Postoperative bleeding was found in one case and skin burns were found in five cases (3.3%). There were no cases of conversion to open surgery or of mortality. Two patient (1.3%) had recurrence.

This is the first multicenter report on robot-assisted breast-conserving surgery, suggesting the technique is feasible and safe. Further comparative and prospective studies are warranted to evaluate patient satisfaction, cost-effectiveness, and long-term surgical and oncological outcomes.