Robot-assisted Axillary Lymph Node Dissection for Axillary Lymph Node Metastasis in Breast Cancer

Current experience with robotic-assisted axillary lymph node dissection (R-ALND) is limited. Axillary lymph node dissection is essential for patients with pathological N2-3 disease, but conventional open surgery carries a risk of injury to the intercostobrachial nerve, leading to sensory deficits, pain, and reduced quality of life. R-ALND may enhance precision through minimally invasive techniques, potentially reducing complications. Patients with breast cancer who underwent R-ALND at our institution between March 2024 and March 2025 were enrolled and analyzed. The procedure used the da Vinci system, following a systematic "bottom-up, back-to-front" sequence for axillary dissection, with emphasis on preserving the intercostobrachial nerve and blood vessels. The clinical characteristics, surgical outcomes, complications, and recurrence of R-ALND were analyzed. The mean operative time was 48.16 ± 9.65 minutes, with a median blood loss of 3.00 (2.00, 5.00) mL. A median of 18.00 (13.00, 22.00) lymph nodes were dissected, of which a median of 1.00 (1.00, 4.00) was metastatic. During a mean follow-up period of 8.70 ± 3.24 months, no cases of hemorrhage, infection, seroma, lymphorrhagia, upper limb lymphedema, or recurrence occurred. R-ALND is a safe and precise technique for axillary lymph node dissection, significantly reducing perioperative complications. Its technical advantages include 3-dimensional visualization and enhanced instrument maneuverability, although further validation of long-term survival benefits is required.