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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 129 -139. doi: 10.3877/cma.j.issn.1674-0807.2024.03.001

指南与共识

机器人乳腺癌手术专家共识
国际机器人乳腺外科手术专家协作组(专家委员会)   
  1. 1. 400038　重庆，陆军军医大学第一附属医院乳腺甲状腺外科
  • 收稿日期:2024-05-10 出版日期:2024-06-01

Expert consensus for robotic breast cancer surgery

International Collaborative Group of Robotic Breast Surgery (Expert Committee)   

  1. 1. Department of Breast and Thyroid Surgery, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
    2. Department of Breast and Thyroid Surgery, First Affiliated Hospital of Army Medical University, Chongqing, 400038, China
  • Received:2024-05-10 Published:2024-06-01
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国际机器人乳腺外科手术专家协作组(专家委员会). 机器人乳腺癌手术专家共识[J]. 中华乳腺病杂志(电子版), 2024, 18(03): 129-139.

International Collaborative Group of Robotic Breast Surgery (Expert Committee). Expert consensus for robotic breast cancer surgery[J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(03): 129-139.

乳腺微创手术具有创伤小、出血少、切口隐蔽、并发症少、功能保护好等优点。机器人手术系统以其智能化、远程化、微创化、数字化在乳腺外科手术中比传统开放或腔镜手术更有优势，诞生了很多新术式，让更多乳腺癌患者获益。与欧美女性相比，亚裔女性乳腺癌年轻化趋势明显，乳房多为中小体积，腺体密度较高，与周围脂肪之间层次分明，更合适远程手术；且亚裔女性术后更易形成瘢痕。因此，机器人辅助乳腺微创技术对于亚裔患者意义重大。鉴于目前手术尚缺乏规范及统一意见，结合国际机器人乳腺癌治疗的最新理论和实践经验，对机器人辅助的保留乳头乳晕的乳房切除术联合假体乳房重建或自体组织乳房重建等手术技术制定了专家共识。

关键词: 乳腺肿瘤, 机器人手术, 共识

Minimally invasive breast surgery has the advantages of reduced trauma and blood loss, aesthetic incision placement, decreased incidence of postoperative complications, and optimal functional conservation. Robotic surgical systems, with their intelligent, remote, minimally invasive, and digital capabilities, are superior to traditional open or laparoscopic techniques for breast surgical operations. Their use has led to the development of many new surgical techniques that have benefited a great number of patients with breast cancer. Compared with that of Western women, the epidemiological profile of breast cancer in Asian women is characterized by an earlier age of onset, predominantly smaller breasts with denser glandular tissue, a distinct anatomical delineation between glandular and adipose tissues, and a greater predisposition to scar formation. Thus, Asian patients are prime candidates for remote breast cancer surgery. Given the current lack of standardization, consensus, and guidelines for robot-assisted nipple-sparing mastectomy with implant or autologous tissue reconstruction, as well as other robotic-assisted procedures, we make this consensus and provide these resources here for Asian patients, with the incorporation of the latest theories and international practical experiences.

Key words: Breast neoplasms, Robotic surgery, Consensus
图1 三孔法机器人辅助的保留乳头乳晕的乳房切除术　a图所示3个切口内分别置入相应的戳卡；b图所示对接机械臂
图2 双孔法机器人辅助的保留乳头乳晕的乳房切除术　a图所示于腋窝切口内置入单孔port，于2个操作孔分别放入2个戳卡，第二孔内置入额外的戳卡；b图所示随后对接机械臂
图3 单孔法机器人辅助的保留乳头乳晕的乳房切除术　a图所示腋窝切口内置入单孔port; b图所示单孔port套上无菌手套，剪开3个手套指尖部，分别放入3个戳卡，随后对接机械臂
图4 机器人辅助的保留乳头乳晕的乳房切除术示意图注：机械臂连接完毕后，插入相应操作器械，在非充气条件下完成手术
图5 使用钛网补片完全包裹乳房假体后行胸肌前假体植入乳房重建
图6 胸肌后假体植入乳房重建　a图所示将补片与胸大肌下缘进行缝合；b图所示由腋窝切口植入乳房假体，使用补片覆盖假体并固定
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