Clinical outcomes in breast cancer patients undergoing direct-to- implant reconstruction after robotic nipple-sparing mastectomy using Da Vinci SP with TilePro display

초록

Goals: Nipple-sparing mastectomy (NSM) using the da Vinci SP robotic system is a minimally invasive procedure that offers cosmetic advantages and has demonstrated favorable clinical outcomes in recent studies. As a result, both NSM and reconstruction are increasingly performed using the robotic SP system. However, during mastectomy, the lack of distinct anatomical landmarks makes it difficult for surgeons to determine the precise area being operated on. Although various preoperative marking techniques are employed, there is no consensus on the most effective method. This study was initiated to explore the potential benefits of using the TilePro display for real-time navigation during robotic NSM. Methods: Between October 2021 and October 2024, a total of 28 patients (29 cases) with breast cancer underwent robotic NSM (RNSM) with direct-to-implant (DTI) reconstruction at our institution (Korea university ansan hospital). For comparison, 36 patients (38 cases) who underwent conventional NSM (C-NSM) during the same period were analyzed. Among the robotic NSM group, 10 patients underwent surgery using the TilePro display, starting from June 2024. Results: The mean weight of resected breast tissue was 317.66 g ± 129.95 in the R-NSM group and 335.89 g ± 172.11 in the C-NSM group, showing no significant difference between the two groups (p = 0.626). The mean mastectomy duration was significantly longer in the R-NSM group (170.22 minutes, SD ± 55.21) compared to the CNSM group (109.13 minutes, SD ± 54.68; p < 0.001). A comparison between R-NSM cases with and without the use of TilePro showed no significant difference in mastectomy duration: 161.11 minutes (SD ± 57.40) with TilePro versus 189.00 minutes (SD ± 48.24) without TilePro (p = 0.181). Similarly, there were no significant differences in total drainage volume (p = 0.430) or total drain duration (p = 0.328) between the two groups. Postoperative acute complications occurred in 2 patients (20.0%) with TilePro use and in 2 patients (10.5%) without TilePro, showing no statistically significant difference (p = 0.482). Conclusions: The use of the da Vinci SP robotic system for NSM demonstrated favorable clinical outcomes, with no significant differences in postoperative recovery metrics compared to C-NSM, despite longer operative times. Additionally, the incorporation of the TilePro display in robotic NSM provided no statistically significant improvements in surgical duration, drainage metrics, or complication rates.