Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua 500, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Minimal invasive surgery research center, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Chang Gung University College of Medicine, Taoyuan City, Taiwan; Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua 500, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
J Plast Reconstr Aesthet Surg. 2020 Aug;73(8):1514-1525. doi: 10.1016/j.bjps.2020.02.021. Epub 2020 Feb 18.
Robotic nipple sparing mastectomy (R-NSM), which uses the da Vinci surgical platform, could perform NSM and immediate breast reconstruction through a small and inconspicuous extra-mammary axillary or lateral chest incision. R-NSM was reported with extremely low nipple areolar complex (NAC) necrosis rate, good cosmetic results, and high patient satisfaction. However, there was little evidence available comparing the effectiveness and safety of R-NSM and conventional NSM (C-NSM) in the management of breast cancer.
A case control comparison study was conducted for patients with breast cancer who underwent R-NSM or C-NSM with immediate gel implant breast reconstruction (IGBR) from July 2011 to September 2019 at a single institution to compare the clinical outcomes, patient-reported esthetic results, and medical cost.
According to the study design, 54 procedures of R-NSM were compared with 62 procedures of C-NSM in the surgical management of breast cancer combined with IGBR. Compared with C-NSM, R-NSM was associated with higher overall satisfaction (92% excellent and 8% good versus 75.6% excellent and 24.4% good, P = 0.046), and wound/scar related outcome in patient-reported esthetic results. The NAC ischemia/necrosis risk, overall complication rate, and blood loss were not significantly different between R-NSM and C-NSM groups. However, longer operation time and higher overall medical cost (10,877 ± 796 versus 5,702 ± 661 US Dollars, P<0.01) was observed in R-NSM group.
Compared with C-NSM, R-NSM showed comparable clinical outcomes and favorable patients' satisfaction with the esthetic results, but at the price of longer operation time and higher cost.
机器人辅助保留乳头的乳房切除术（R-NSM）利用达芬奇手术平台，可通过小而隐蔽的乳房外腋窝或侧胸切口进行 NSM 和即刻乳房重建。R-NSM 报道的乳头乳晕复合体（NAC）坏死率极低，美容效果好，患者满意度高。然而，在乳腺癌的管理中，R-NSM 与传统 NSM（C-NSM）的有效性和安全性比较的证据很少。
对 2011 年 7 月至 2019 年 9 月在一家机构接受 R-NSM 或 C-NSM 联合即刻凝胶植入乳房重建（IGBR）的乳腺癌患者进行病例对照比较研究，比较两组的临床结果、患者报告的美容效果和医疗费用。
根据研究设计，在乳腺癌的手术治疗中，54 例 R-NSM 与 62 例 C-NSM 联合 IGBR 进行比较。与 C-NSM 相比，R-NSM 与更高的整体满意度（92%为优秀，8%为良好，75.6%为优秀，24.4%为良好，P=0.046）和患者报告的美容效果中的伤口/疤痕相关结果相关。R-NSM 和 C-NSM 组的 NAC 缺血/坏死风险、总并发症率和失血量无显著差异。然而，R-NSM 组的手术时间更长，总医疗费用更高（10877±796 美元 vs. 5702±661 美元，P<0.01）。
与 C-NSM 相比，R-NSM 具有相似的临床结果和良好的患者对美容效果的满意度，但手术时间更长，成本更高。
