Robotic breast surgery with and without tunneling using the tumescent technique

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Breast Surgery

Background:

• The tumescent technique is traditionally used in nipple-sparing mastectomy (NSM) to aid dissection and minimize bleeding.
• Its role in robotic nipple-sparing mastectomy (RNSM) is uncertain due to the enhanced visualization provided by robotic systems.

Purpose of the Study:

• To evaluate the feasibility of omitting the tumescent technique in RNSM.
• To compare postoperative outcomes and operative times between RNSM with and without tumescent infiltration.

Main Methods:

• Retrospective review of 253 patients undergoing unilateral RNSM.
• Comparison of adverse events (Clavien-Dindo system) and operative times.
• Utilized Indocyanine green (ICG) fluorescence imaging to assess ischemia patterns.

Main Results:

• The non-tumescent group showed significantly lower rates of adverse events (5.2% vs. 16.3%) and hematomas (2.4% vs. 11.6%) compared to the tumescent group.
• While mastectomy operative time was shorter with tumescent, overall surgical time did not differ significantly.
• ICG imaging revealed higher rates of diffuse and nipple-areolar complex (NAC) ischemia in the tumescent group, but these did not correlate with severe adverse events.

Conclusions:

• Omitting the tumescent technique in RNSM is a feasible approach.
• This omission may lead to reduced postoperative complications, particularly hematomas.
• It allows for comparable operative times and potentially reduces unnecessary flap trimming due to ICG fluorescence imaging.