Single-port robotic nipple-sparing mastectomy: a systematic review and single-arm meta-analysis of safety and process outcomes

Single-port robotic nipple-sparing mastectomy (SP-RNSM) represents the latest advancement in minimally invasive breast surgery. This review aimed to synthesize current evidence regarding perioperative safety, procedural benchmarks, learning-curve characteristics, and patient-centered outcomes specific to the da Vinci SP platform.

A systematic review was performed to identify studies published between 2024 and 2025 in the United States and Korea. When single-port subgroup data were explicitly available, single-arm meta-analyses were conducted.

Three eligible studies were included. Pooled analyses demonstrated uniformly low complication rates with negligible heterogeneity: reoperation (Clavien-Dindo ≥ III) ~ 4%, and hematoma, infection, nipple-areolar complex (NAC) necrosis, and skin-flap necrosis each ~ 1%. Conversion to open surgery was rare, supporting the short-term safety of this approach under appropriate patient selection. Although process outcomes were reported heterogeneously, they were consistently acceptable: median bilateral operative time of approximately 277 min in a U.S. cohort, console time 116-124 min, and pre-docking time about 45 min. Learning-curve assessments showed progressive reduction in operative time without a distinct plateau. A high-volume Korean series quantified a 13-minute increase per additional 100 g of specimen weight, whereas exploratory sensory testing in a U.S. cohort revealed partial preservation of nipple and breast-skin sensibility, suggesting potential quality-of-life benefits. Conclusions: SP-RNSM appears technically feasible and safe, with reproducible operative and workflow benchmarks. Current evidence remains limited by small, single-arm cohorts; thus, future priorities include multicenter prospective comparisons (SP vs. multi-port vs. conventional techniques), establishment of standardized core outcome sets integrating objective sensibility testing and validated patient-reported instruments, long-term oncologic surveillance, and cost-effectiveness analyses to facilitate structured clinical adoption.