Abstract P2-14-25: Application of robotic surgery (da Vinci) in the management of breast cancer- Preliminary results and experience sharing
Authors: Lai H-W , Chen S-T , Chen D-R , Kuo S-J , Lin S-L 
Published: May 2019

Abstract
Background: The experience of application of robotic surgery platform in the management of breast cancer was limited. The preliminary results of robotic surgery (da Vinci) in the management of breast cancer was reported in current study.
Methods: Patients with breast cancer received robotic breast surgeries from March 2017 to June 2018 were searched from robotic breast surgery database at Changhua Christian Hospital, Taiwan. Data on clinicopathologic characteristics, type of surgery, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of robotic breast surgery. Patient-reported cosmetic outcome result was also obtained.
Results: During the study period, a total of 41 robotic breast surgeries were performed in 35 female breast cancer patients, including 6 patients with bilateral disease. Among these 41 robotic breast procedures, 39 were R-NSM related. Four patients with bilateral R-NSM (two patients with bil. breast cancer, and another two patients received contralateral prophylatic mastectomy (CPM)) without breast reconstruction. The other 31 R-NSM were associated with immediate breast reconstruction (IBR). Two patients received R-NSM and IBR with robotic assisted harvest of latissimus dorsi flap (RAHLDF), and 29 patients received R-NSM and IBR with Gel implant procedures. One patient received robotic assisted quadrantectomy for upper outer located large breast cancer and immediate partial breast reconstruction with RAHLDF. The other patient received endoscopic assisted partial mastectomy for upper inner located multifocal breast cancer and immediate partial breast reconstruction with robotic assisted harvest of omentum flap.
Among those patients who received R-NSM, the mean operation time for R-NSM (after set-up of robotic breast surgery system) was 115.6 ± 50 mins, and 70.2 ± 23.2 mins for Gel implant reconstruction. The docking time was quickly dropped from 20 mins to 6-8 mins, and the time needed to complete R-NSM could usually be completed within 100mins after accumulated cases' experience. The mean blood loss was 35 ± 37.2 ml. The positive surgical margin rate for R-NSM was 2.6%(1/39), which was superficial margin involvement, and no further surgery was performed. About 13% patients suffered from transit nipple ischemia change, and no total nipple areolar complex necrosis case was observed.
Among those 3 patients who received RAHLDF, it took about 267 mins, 97 mins, and 90 mins to complete the 1st, 2nd, and 3rd RAHLDF, separately. All of them were event free, except seroma formation over the back, which relived after repeat aspiration.
No local recurrence, or mortality was found among these 35 patients during mean 8.9 ± 4.2 months follow-up. The patient-reported survey shows that 97%(32/33) of the patients who received robotic breast surgery with breast reconstruction satisfied the cosmetic outcome.
Conclusion: From our preliminary experience, robotic breast surgery is a feasible and safe option for some selected indications of breast cancer patients. R-NSM and IBR with Gel implant or RAHLDF were the most frequent performed operations. Bilateral R-NSM could be safely performed in bilateral breast cancer patients or unilateral breast cancer patients combined with CPM.
Citation Format: Lai H-W, Chen S-T, Chen D-R, Kuo S-J, Lin S-L. Application of robotic surgery (da Vinci) in the management of breast cancer- Preliminary results and experience sharing [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-25.