Robotic surgery may sound futuristic, but it’s been used for several years, and its benefit for certain surgical procedures has been proven. Hysterectomy, cardiac bypass, and operations for prostate, kidney and bladder cancer, to name a few, can be performed with robotic technology. And now, robotics are entering the realm of mastectomy and breast reconstruction.
If you’re squeamish about having a robot perform your procedure, no worries. Although the term conjures images of human-like machines standing over patients in the operating room, surgical robotics are highly-sophisticated mechanical arms that are controlled by a specially-trained surgeon from a nearby computer console. One robotic arm provides a magnified, 3-D high-definition view of the patient’s blood vessels, tissue and organs in the surgical area. Other arms hold miniature instruments that perform the procedure.
Watching the enhanced images, surgeons use finger and foot controls to operate robotic arms. Each movement of the surgeon’s hand, wrist, and fingers guide the robotic wrists, which performs the same movements, but does so with greater dexterity and flexibility. With the ability to bend and rotate to a greater degree, robots use miniature surgical instruments to perform smaller, more delicate movements than can be made with the human hand. The equipment mimics each movement exactly, but on a smaller scale and with far greater precision—it can accomplish in one-quarter inch what its human counterpart requires one inch to perform, for example. For the patient, minimally-invasive robotic surgery results in less surgical trauma, minimal blood loss and fewer post-operative infections and other complications. It also means a quicker, less painful recovery and smaller scars.
Surgeons in the U.S., Europe and Japan are using robotics to perform nipple-sparing mastectomy and immediate breast reconstruction with tissue expanders/implants and latissimus dorsi flaps. A small study at the University of Michigan found that endoscopic mastectomy and immediate reconstruction with tissue expanders shortened operative time, reduced the rate of complications, and shortened patients’ hospital stays.
Traditional lat flap reconstruction involves a long incision down the back through which the latissimus dorsi muscle is harvested and tunneled under the skin to the mastectomy site. With robotic technology, the muscle is harvested endoscopically: the entire procedure is performed through a small incision in the underarm, requiring no incision on the back. A clinical trial using robotics to perform breast reconstruction with latissimus dorsi flaps at MD Anderson Cancer Center in Houston is currently open and recruiting participants.
Using robotics for mastectomy and breast reconstruction is in its earliest stages, and is by no means standard practice. Nor is it available everywhere. It requires facilities that have the sophisticated robotic equipment, which is expensive to purchase and maintain, and surgeons who are trained to program and operate it.
Toesca A, Peradze N, Galimberti V, et al. “Robotic Nipple-sparing Mastectomy and Immediate Breast Reconstruction With Implant: First Report of Surgical Technique.” Annals of Surgery. 2015 Oct 21. [Epub ahead of print]
Clemens MW, Kronowitz S, Selber JC. “Robotic-assisted latissimus dorsi harvest in delayed-immediate breast reconstruction.” Seminars in Plastic Surgery. 2014 Feb; 28(1): 20-25.
Chung JH, You JH, Kim HS, et al. “A novel technique for robot assisted latissimus dorsi flap harvest.” Journal of Plastic, Reconstructive & Aesthetic Surgery 2015 Jul; 68(7): 966-72.
Toranto JD, Yu D, Cederna PS. “Endoscopic versus open tissue-expander placement: is less invasive better?” Plastic and Reconstructive Surgery 2007 Mar; 119(3): 894-906.