Hung-Wen Lai1, Chuan-Cheng Wang2, Yi-Chun Lai3, Chih-Jung Chen4, Shih-Lung Lin5, Shou-Tung Chen6, Ying-Jen Lin7, Dar-Ren Chen8, Shou-Jen Kuo9. 1. Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan; 135 Nanxiao Street, Changhua 500, Taiwan. Electronic address: hwlai650420@yahoo.com.tw. 2. Division of Hematology & Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; 135 Nanxiao Street, Changhua 500, Taiwan. Electronic address: 114992@cch.org.tw. 3. Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; 135 Nanxiao Street, Changhua 500, Taiwan. Electronic address: 180052@cch.org.tw. 4. Department of Surgical Pathology, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 135 Nanxiao Street, Changhua 500, Taiwan. Electronic address: 132540@cch.org.tw. 5. Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; 135 Nanxiao Street, Changhua 500, Taiwan. Electronic address: 103280@cch.org.tw. 6. Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; 135 Nanxiao Street, Changhua 500, Taiwan. Electronic address: 1886@cch.org.tw. 7. Tumor Center, Changhua Christian Hospital, Changhua, Taiwan; 135 Nanxiao Street, Changhua 500, Taiwan. Electronic address: 180681@cch.org.tw. 8. Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; 135 Nanxiao Street, Changhua 500, Taiwan. Electronic address: 115045@cch.org.tw. 9. Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; 135 Nanxiao Street, Changhua 500, Taiwan. Electronic address: 40225@cch.org.tw.
Abstract
BACKGROUND: The preliminary experience and learning curve of robotic nipple sparing mastectomy (R-NSM) in the management of breast cancer were analyzed and reported. METHODS: The medical records of patients who underwent R-NSM for breast cancer during the period of March 2017 to June 2018 were collected from the same surgeon in a single institute. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, and operation time were prospective collected. Learning curve of R-NSM was evaluated and analyzed by the cumulative sum (CUSUM) plot method. RESULTS: A total of 39 consecutive R-NSM procedures from 35 patients were analyzed. The time needed for "docking", "R-NSM", and "R-NSM and immediate prosthesis breast reconstruction (IPBR)" decreased after cases experience accumulated, and in mature phase procedures could finished within 10 min, 100mins, and 240 min, separately. In CUSUM plots analysis of learning curve, the cases needed to decrease operation time for "docking", "R-NSM", and "total time for R-NSM and IPBR" were 13th, 13th, and 12th procedures separately. Mastectomy weight and lymph node metastasis were factors related to operation time. The rate of total nipple areolar complex necrosis for R-NSM was 0%. One (2.9%, 1/35) R-NSM procedure was found to have positive margin involved in the final pathologic check-up. No implant loss, or local recurrence was observed during a mean follow-up of 8.6 ± 4.5 (1.3-16.7) months. CONCLUSION: From our preliminary experience, R-NSM and IPBR (or R-NSM alone) is a safe procedure, and the operation time needed significantly decrease after cases experience accumulated.
BACKGROUND: The preliminary experience and learning curve of robotic nipple sparing mastectomy (R-NSM) in the management of breast cancer were analyzed and reported. METHODS: The medical records of patients who underwent R-NSM for breast cancer during the period of March 2017 to June 2018 were collected from the same surgeon in a single institute. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, and operation time were prospective collected. Learning curve of R-NSM was evaluated and analyzed by the cumulative sum (CUSUM) plot method. RESULTS: A total of 39 consecutive R-NSM procedures from 35 patients were analyzed. The time needed for "docking", "R-NSM", and "R-NSM and immediate prosthesis breast reconstruction (IPBR)" decreased after cases experience accumulated, and in mature phase procedures could finished within 10 min, 100mins, and 240 min, separately. In CUSUM plots analysis of learning curve, the cases needed to decrease operation time for "docking", "R-NSM", and "total time for R-NSM and IPBR" were 13th, 13th, and 12th procedures separately. Mastectomy weight and lymph node metastasis were factors related to operation time. The rate of total nipple areolar complex necrosis for R-NSM was 0%. One (2.9%, 1/35) R-NSM procedure was found to have positive margin involved in the final pathologic check-up. No implant loss, or local recurrence was observed during a mean follow-up of 8.6 ± 4.5 (1.3-16.7) months. CONCLUSION: From our preliminary experience, R-NSM and IPBR (or R-NSM alone) is a safe procedure, and the operation time needed significantly decrease after cases experience accumulated.
Authors: Olivia Quilichini; Julien Barrou; Marie Bannier; Sandrine Rua; Aurore Van Troy; Laura Sabiani; Eric Lambaudie; Monique Cohen; Gilles Houvenaeghel Journal: Ann Med Surg (Lond) Date: 2020-12-31
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