Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan.
Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan.
Ann Surg. 2020 Jun;271(6):1005-1012. doi: 10.1097/SLA.0000000000003789.
OBJECTIVES: To achieve a consensus statement on robotic mastectomy. BACKGROUND: Robotic-assisted surgery has gained much attention especially the results of few case series reporting on the technical feasibility, safety and early oncologic outcomes of robotic-assisted mastectomy in a few centers worldwide. The aim of this consensus statement was to develop and provide standardized guidelines on robotic mastectomy based on consensus statement by a panel of experts from indications to outcome measures and indicators, thereby providing a valuable guide for breast surgeons worldwide. METHODOLOGY: An internationally representative expert panel of 10 surgeons was invited to participate in the generation of a consensus statement. 52 statements were created in 6 domains: indications, contraindications, technical considerations, patient counseling, outcome measures and indicators, training and learning curve assessment. Experts were asked to vote if they agree, disagree or of the opinion that the statement should be rephrased. Two electronic rounds via online survey of iterative rating and feedback were anonymously completed, followed by a final round of in-person meeting during the inaugural International Endoscopic and Robotic Breast Surgery Symposium 2019 from May 24 to 25, 2019. Consensus was reached when there was at least 80% agreement on each statement. RESULTS: A total of 53 statements with at least 80% agreement were generated after 3 rounds of voting; 21 statements from first round of voting, 20 statements from second round of voting and 12 statements from the final round of in-person meeting. All experts agreed that the consensus statement served as expert recommendations but not mandatory for a successful and safe practice of robotic mastectomy. CONCLUSION: Robotic mastectomy is a promising technique and could well be the future of minimally invasive breast surgery whereas proving to be safe and feasible. The first consensus statement on robotic mastectomy from an international panel of experts serves as an extremely important milestone and provides recommendations for breast surgeons keen to embark on this technique.
目的：达成机器人乳房切除术的共识声明。
背景：机器人辅助手术备受关注，尤其是少数中心报告的几例机器人辅助乳房切除术的技术可行性、安全性和早期肿瘤学结果的病例系列研究结果。本共识声明的目的是基于来自世界各地的 10 位外科专家小组的共识声明，制定并提供机器人乳房切除术的标准化指南，为全球乳腺外科医生提供有价值的指导。
方法：邀请了 10 位具有国际代表性的外科专家组成员参与共识声明的制定。在 6 个领域创建了 52 个陈述：适应证、禁忌证、技术考虑、患者咨询、结局测量和指标、培训和学习曲线评估。专家们被要求对他们是否同意、不同意或认为该陈述应重新措辞进行投票。通过在线调查进行了两轮电子投票，对迭代评分和反馈进行匿名投票，随后在 2019 年 5 月 24 日至 25 日举行的第一届国际内窥镜和机器人乳房外科手术研讨会上进行了最后一轮面对面会议。当每个陈述至少有 80%的专家达成一致时，即达成共识。
结果：经过三轮投票，共产生了 53 个至少有 80%专家达成一致的陈述；第一轮投票产生 21 个陈述，第二轮投票产生 20 个陈述，最后一轮面对面会议产生 12 个陈述。所有专家一致认为，共识声明是专家建议，但不是机器人乳房切除术成功和安全实践的强制性要求。
结论：机器人乳房切除术是一种很有前途的技术，并且可以成为微创乳房手术的未来，证明是安全可行的。来自国际专家小组的第一份机器人乳房切除术共识声明是一个极其重要的里程碑，为热衷于开展这项技术的乳腺外科医生提供了建议。
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