Skin sparing mastectomy and robotic latissimus dorsi-flap reconstruction through a single incision

Gilles Houvenaeghel,Sandrine Rua,Monique Cohen,Marie Bannier,Julien Barrou,Eric Lambaudie,Mellie Heinemann

doi:10.1186/s12957-019-1711-8

Abstract

BackgroundRobotic latissimus dorsi-flap reconstruction (RLDFR) after skin-sparing mastectomy (SSM) for breast cancer (BC) has been performed through a single nipple incision. We report results of SSM with RLDFR, mainly with analysis of feasibility, morbidity, indications, and technique standardization.MethodsWe determined characteristics of patients, previous treatment of BC, and type of reconstruction. Surgical technique, duration of surgery, and complication rate were reported according to three successive periods: P1–3.ResultsForty RLDFR, with breast implant for 16 patients, with previous breast radiotherapy in 30% had been performed. In logistic regression, factors significantly associated with duration of surgery ≥ 300 min were P2 (OR 0.024, p = 0.004) and P3 (OR 0.012, p = 0.004) versus P1. The median mastectomy weight was 330 g and 460 g for BMI < and ≥ 23.5 (p = 0.025). Length of hospitalization was 4 days. Total complication rate was 20% (8/40): seven breast complications (four re-operations) and one RLDF complication with re-operation. Periods were significantly predictive of complications (p = 0.045).ConclusionSSM with RLDFR is feasible, safe, and reproducible. We reported a decrease of duration of surgery, length of post-operative hospitalization, and complication rate.

Highlights

Development of robotic surgery since several years was very important for prostatic cancer, gynecologic cancer, colo-rectal cancer, and thoracic and thyroid surgery [1,2,3]
Skinsparing mastectomy (SSM) with LDF reconstruction was reported in 17 patients for delayed-immediate breast reconstruction after SSM and placement of a tissue expander [13] and in one patient for immediate breast reconstruction with 3D endoscopy using another incision than areolar incision [15]
During the study period of 29 months, 119 patients were operated for breast surgery and/or Robotic latissimus dorsi-flap reconstruction (RLDFR), 117 with da Vinci robot, and 2 with 3D endoscopy

Summary

Introduction

Development of robotic surgery since several years was very important for prostatic cancer, gynecologic cancer, colo-rectal cancer, and thoracic and thyroid surgery [1,2,3]. Endoscopic non-robotic latissimus dorsi-flap breast reconstruction (LDFR) has been reported in several studies [4,5,6,7,8,9]. Nipple-sparing mastectomy (NSM) with immediate robotic latissimus dorsi-flap (RLDF) reconstruction has been reported in seven patients in Selber et al.’s study [10] and in four cases in Chung et al.’s study [12]. The aim of this study was to report results of SSM with robotic LDFR performed during 29 months, through the analysis of feasibility, morbidity, indications, and standardization of patient positioning and operative technique. Robotic latissimus dorsi-flap reconstruction (RLDFR) after skin-sparing mastectomy (SSM) for breast cancer (BC) has been performed through a single nipple incision. We report results of SSM with RLDFR, mainly with analysis of feasibility, morbidity, indications, and technique standardization

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Discussion

Conclusion