Endoscopic and Robotic Minimally Invasive Breast Surgery (MIBS) for Benign Breast Lesions: Our Experience of 80 Cases...

Minimally invasive breast surgery (MIBS) via an extramammary approach offers an alternative to conventional open lumpectomy, eliminating breast scarring and improving psychological outcomes in patients with benign breast lesions. While endoscopic MIBS (EMIBS) has been described, data on robotic MIBS (RMIBS) are sparse. We analyzed the clinical and cosmetic outcomes of EMIBS and RMIBS.

Eighty patients undergoing MIBS for benign breast lumps were divided into endoscopic (n = 40) and robotic (n = 40) groups. Primary endpoints included cosmetic outcomes [evaluated via Patient and Observer Scar Assessment Scale (POSAS) and BREAST-Q], total operative and docking times, and complications, which were statistically analysed (IBM SPSS Statistics version 30).

Groups were comparable in age (p = 0.325), lesion size (median 2.0 vs. 2.75 cm; p = 0.247), and number of lumps (median 1 in both groups; p = 0.165). Operative time analysis showed that operative time was significantly longer in the robotic group (median 150 vs. 95 minutes; p<0.001). Complications were minor, self-resolving, and comparable across both groups (Fisher's exact p = 0.647). Cosmetic outcomes (at 1 month) were comparable between the two groups: median POSAS score 2 and median BREAST-Q score 88 (breast-conserving therapy module, satisfaction with breasts subscale). A subjective reduction in physical strain on the surgeon was noted in the robotic group; no objective ergonomic measurements were performed.

We demonstrate the feasibility and safety of both approaches for benign breast lesions, with comparable and favorable cosmetic outcomes, and with the robotic platform offering subjective improvement in ergonomic strain, especially in difficult-to-access medial quadrants. These findings are hypothesis-generating and require validation using instruments such as NASA-TLX or the Borg CR-10 scale in larger studies.