67: Q&A

Saturday, March 12, 2022

10:39 AM – 10:41 AM CST

Location: Chantilly East

Abstract Presenter(s)

Daniel B. Hewitt, MD, MPH, MS

Surgical Oncology Fellow
The Ohio State University Medical Center - Columbus, OH
Columbus, Ohio, United States

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Participants should be aware of the following financial/non-financial relationships:

Daniel B. Hewitt, MD, MPH, MS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Introduction: We obtained an Investigational Device Exemption (IDE) from the FDA to open a pilot study to determine the safety, efficacy, and potential risks of robotic-assisted nipple-sparing mastectomy (RNSM). This video documents the first U.S. investigator-initiated RNSM using a single incision.

Methods: A 32-year-old female presented with a palpable right breast mass. Workup revealed invasive ductal carcinoma. She received a bilateral RNSM with a right sentinel lymph node biopsy and immediate reconstruction.

Results: A clock pattern was marked on the breast to allow the bedside assist to guide the operating surgeon during the dissection. A 3 cm incision was made in the mid-axillary line at the level of the nipple. Working space was dissected free at the most lateral portion of the breast. A combination of saline injection and scissors was used to create space in the subcutaneous plane for insufflation. The single incision port system (GelPOINT Mini, Applied Medical) was combined with a small wound protector (Alexis Wound Protector, Applied Medical) and inserted into the incision. The da Vinci Xi robotic platform was docked. Dissection was performed with a fenestrated bipolar (arm 1), camera (arm 2), and monopolar scissors (arm 3). The posterior dissection was performed first as the insufflation and remaining anterior attachments to the breast parenchyma kept the breast elevated and assisted with exposure of the posterior plane. Furthermore, posterior dissection along the lateral border of the sternum allows for easier identification of perforating vessels. During the dissection of the upper inner quadrant, the robot provided excellent visualization and access to a traditionally difficult area. Once the dissection was complete, the breast specimen was removed en bloc and oriented in the usual fashion for pathologic evaluation. Reconstruction was completed by placing pre-pectoral bilateral tissue expanders with acellular dermal matrix. The patient went home on POD 1.

Conclusions: Bilateral RNSM is a feasible operation that provides superior visualization, enhanced precise movement from more degrees of freedom, better access to small or difficult to reach spaces, and improved surgeon ergonomics compared with traditional NSM.

Learning Objectives:

Upon completion of the video, participants will be able to discuss the benefits to robotic mastectomy
Upon completion of the video, participants will be able to list the steps of robotic mastectomy
Upon completion of the video, participants will be able to describe where to place the surgical incision