Title : Comparison of single-port robotic breast conserving surgery and conventional open pattern for early breast cancer

Background: Breast-conserving surgery is one of standard surgical modalities for early-stage breast cancer. Conventional breast-conserving surgery (C-BCS) is typically conducted by two incisions, and the incision on the breast surface compromises aesthetic outcome. This study introduces a single-incision robotic breast-conserving surgery (SIR-BCS) performed and compares the differences in surgical effectiveness and aesthetic outcomes between SIR-BCS and C-BCS.

Method: We innovatively adopt an incisional retractor fixator to enable single-port surgery using multi-arm surgical robot. Based on our team’s previously established single-port laparoscopic breast-conserving surgical protocol, we further developed and validated a safe, standardized operative procedure for single-port robotic breast-conserving surgery. Methylene blue is first used for circumferential marking of the resection margin. The superficial layer of the superficial fascia at the target resection site is then infiltrated with epinephrine saline solution, followed by sharp dissection with a scalpel. The robotic system is subsequently operated to perform extended local excision. 53 patients with early-stage breast cancer were enrolled in this study, of whom 19 underwent SIR-BCS and 34 underwent C-BCS. The clinical-pathological characteristics were evenly distributed between the two cohorts. Aesthetic outcomes were evaluated using the BREAST-Q scale.

Results: The mean incision length was remarkably shorter for SIR-BCS than for C-BCS. The patients in SIR-BCS cohort remains higher satisfaction of breasts than patients in C-BCS cohort and numerically higher score of psychological well-being. While duration of operation, blood loss and drainage duration of SIR-BCS were consistent with C-BCS.

Conclusion: Single-incision robotic breast conserving surgery offers better aesthetic outcome and psychological status, compared with conventional open approach. Single-port robotic breast-conserving surgery is a feasible option for breast-conserving resection for early-stage breast cancer treatment.

Prof. Wang is a surgeon specializing in breast cancer and minimal invasive surgery including endoscopic and robotic pattern. Prof. Wang is a Chief Surgeon, Associate Professor. Prof. Wang holds a MD in Surgery from Peking University and had worked as Postdoctoral Fellow at Siteman Cancer Center, Washington University in St. Louis. Prof. Wang is a pioneer in China performing single-port laparoscopic breast cancer surgery. Prof. Wang has completed the largest number of single-port procedures domestically, including single-port breast reconstruction, single-port breast-conserving surgery for breast cancer, endoscopic indocyanine green-guided sentinel lymph node biopsy, endoscopic breast plasty with greater omentum, single-port gynecomastia resection and endoscopic accessory breast excision.