切换至 "中华医学电子期刊资源库"

中华乳腺病杂志(电子版) ›› 2026, Vol. 20 ›› Issue (01) : 9 -15. doi: 10.3877/cma.j.issn.1674-0807.2026.01.002

专家论坛

机器人技术在乳腺外科的临床应用
陈阔1, 齐晓伟2, 宋达疆3, 吕鹏威1,()   
  1. 1 450052 郑州,郑州大学第一附属医院乳腺外科
    2 400038 重庆,陆军军医大学第一附属医院乳腺甲状腺外科
    3 410008 长沙,中南大学湘雅医学院附属肿瘤医院/湖南省肿瘤医院乳腺肿瘤整形科
  • 收稿日期:2025-10-26 出版日期:2026-02-01
  • 通信作者: 吕鹏威
  • 基金资助:
    国家科技重大专项(2025ZD0543900)

Clinical application of robotic technology in breast surgery

Kuo Chen1, Xiaowei Qi2, Dajiang Song3, Pengwei Lyu1,()   

  1. 1 Department of Breast Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
    2 Department of Breast and Thyroid Surgery, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
    3 Department of Breast Oncology and Plastic Surgery, Hunan Cancer Hospital/ Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410008, China
  • Received:2025-10-26 Published:2026-02-01
  • Corresponding author: Pengwei Lyu
引用本文:

陈阔, 齐晓伟, 宋达疆, 吕鹏威. 机器人技术在乳腺外科的临床应用[J/OL]. 中华乳腺病杂志(电子版), 2026, 20(01): 9-15.

Kuo Chen, Xiaowei Qi, Dajiang Song, Pengwei Lyu. Clinical application of robotic technology in breast surgery[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2026, 20(01): 9-15.

机器人乳腺手术的核心应用包括机器人保留乳头乳晕的乳房切除术及同期重建、机器人自体组织获取与乳房重建、单孔入路保留乳房手术、机器人腋窝淋巴结清扫等。现有研究提示:在规范适应证选择与成熟团队实施下,机器人乳腺手术近期安全性与肿瘤学疗效与传统术式相当,部分研究显示其在乳头坏死、严重并发症、切口隐蔽与患者美学满意度方面具有优势,但仍受制于设备与耗材成本、手术准备与耗时、力反馈不足、狭小空间器械干扰、团队培训门槛等问题。本文围绕机器人技术在乳腺外科的临床应用进行系统综述,梳理其技术演进与平台发展,并重点总结当前可开展的主要术式及证据现状。未来,随着5G远程手术、设备国产化以及乳腺专用机器人与人工智能影像导航等融合发展,机器人有望推动乳腺外科进一步向精准化、微创化与个体化演进;同时亟需更多多中心高质量研究与长期随访以验证远期肿瘤学结局与功能及美学获益的稳健性。

The principal applications of robotic breast surgery include robotic nipple-sparing mastectomy (RNSM) with immediate reconstruction, robotic harvest of autologous tissue for breast reconstruction, single-port robotic breast-conserving surgery, and robotic axillary lymph node dissection. Overall, existing studies suggest that with appropriate patient selection and implementation by experienced teams, robotic breast surgery offers short-term safety and oncologic outcomes comparable to those of conventional techniques. Some researches indicate potential advantages in reducing nipple necrosis and major complications, improving incision concealment, and enhancing aesthetic satisfaction. However, its wider adoption remains constrained by high cost of equipments and consumables, longer setup and operative time, lack of haptic feedback, instrument interference in confined working spaces, and substantial training requirements. This article provides a systematic review of the clinical applications of robotic technology in breast surgery, outlining the evolution of related techniques and surgical platforms and summarizing the main procedures currently feasible in practice as well as the available evidence. In the future, with advances such as 5G-enabled telesurgery, domestic manufacturing, and the integration of dedicated breast robotic systems with AI-based imaging navigation, robotic surgery may further promote precise, minimally invasive and individualized approaches in breast surgery. Nevertheless, more high-quality multicenter studies with long-term follow-up are needed to validate durable oncologic outcomes and the robustness of functional and aesthetic benefits.

[1]
Kwoh YSHou JJonckheere EA,et al. A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery [J]. IEEE Trans Biomed Eng198835(2):153-160.
[2]
Smith JAJivraj JWong R,et al. 30 Years of neurosurgical robots:review and trends for manipulators and associated navigational systems [J]. Ann Biomed Eng201644(4):836-846.
[3]
Jacobs LKShayani VSackier JM. Determination of the learning curve of the AESOP robot [J]. Surg Endosc199711(1):54-55.
[4]
魏勇,沈露明,刘威,等. 达芬奇机器人SP系统在泌尿外科的应用与发展 [J]. 机器人外科学杂志(中英文)20245(3):307-311.
[5]
Vanmulken TJMSchols RMScharmga MJ,et al. First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema:a randomized pilot trial [J]. Nat Commun202011(1):757.
[6]
张聚良,杨柳,张明坤,等. 达芬奇机器人在乳腺癌根治切除并一期假体重建中的临床应用 [J]. 中国普外基础与临床杂志202229(11):1415-1420.
[7]
陈阔,吕鹏威. 达芬奇机器人乳腺外科手术151例 [J]. 中华普通外科杂志202439(7):516-520.
[8]
赵烨,赵菁,李开富,等. 达芬奇机器人在乳腺微创外科中的应用 [J]. 国际外科学杂志202552(2):73-79.
[9]
Lee JPark HSLee H,et al. Post-operative complications and nipple necrosis rates between conventional and robotic nipple-sparing mastectomy [J]. Front Oncol202010:594388.
[10]
陈阔,吕鹏威. 达芬奇机器人辅助保留乳头乳晕乳腺切除即刻假体联合背阔肌组织瓣乳房重建的初步探索 [J]. 组织工程与重建外科202420(5):522-527.
[11]
Fouarge ACuylits N. From open to robotic-assisted latissimus dorsi muscle flap harvest [J]. Plast Reconstr Surg Glob Open20208(1):e2569.
[12]
Kuo WLHuang JJHuang YT,et al. Robot-assisted mastectomy followed by immediate autologous microsurgical free flap reconstruction:techniques and feasibility in three different breast cancer surgical scenarios [J]. Clin Breast Cancer202020(1):e1-e8.
[13]
Lai HWChen STLin SL,et al. Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer:a case report [J]. Medicine(Baltimore)201897(27):e11373.
[14]
Selber J CBaumann DPHolsinger FC. Robotic latissimus dorsi muscle harvest:a case series [J]. Plast Reconstr Surg2012129(6):1305-1312.
[15]
Joo OYSong SYLew DH,et al. Robotic harvest of a latissimus dorsi flap using a single-port surgical robotic system in breast reconstruction [J]. Arch Plast Surg202148(6):577-582.
[16]
Vourtsis SAPaspala ALykoudis PM,et al. Robotic-assisted harvest of latissimus dorsi muscle flap for breast reconstruction:review of the literature [J]. J Robot Surg202216(1):15-19.
[17]
Houvenaeghel GBannier MRua S,et al. Robotic breast and reconstructive surgery:100 procedures in 2-years for 80 patients [J]. Surg Oncol201931:38-45.
[18]
Houvenaeghel GElhajj HSchmitt A,et al. Robotic-assisted skin sparing mastectomy and immediate reconstruction using latissimus dorsi flap a new effective and safe technique:a comparative study [J]. Surg Oncol202035:406-411.
[19]
Chen KZhang JBeeraka NM,et al. Robotic nipple sparing mastectomy and immediate breast reconstruction:significant attempts with the latissimus dorsi muscle without island flap [J]. Minerva Surg202479(4):411-418.
[20]
陈显春,阎文婷,吴秀娟,等. 达芬奇机器人辅助下乳腺癌带蒂大网膜乳房填充重建术 [J]. 局解手术学杂志201726(11):823-826.
[21]
Gundlapalli VSOgunleye AAScott K,et al. Robotic-assisted deep inferior epigastric artery perforator flap abdominal harvest for breast reconstruction:a case report [J]. Microsurgery201838(6):702-705.
[22]
Choj JHSong SYPark HS,et al. Robotic DIEP flap harvest through a totally extraperitoneal approach using a single-port surgical robotic system [J]. Plast Reconstr Surg2021148(2):304-307.
[23]
Daar DAAnzai LMVranis NM,et al. Robotic deep inferior epigastric perforator flap harvest in breast reconstruction [J]. Microsurgery202242(4):319-325.
[24]
Dayaratna NAhmadi NMak C,et al. Robotic-assisted deep inferior epigastric perforator (DIEP) flap harvest for breast reconstruction [J]. ANZ J Surg202393(4):1072-1074.
[25]
Lee MJWon JSong SY,et al. Clinical outcomes following robotic versus conventional DIEP flap in breast reconstruction:a retrospective matched study [J]. Front Oncol202212:989231.
[26]
刘军,王子函,李梦新,等. 单孔机器人保留乳房手术初步探索[J/OL]. 中华腔镜外科杂志(电子版)202518(3):162-165.
[27]
李婷婷,陈莉. 机器人在乳腺手术中的困境与挑战 [J]. 临床外科杂志202432(3):228-230.
[28]
Ahn JHPark JMChoi SB,et al. Early experience of robotic axillary lymph node dissection in patients with node-positive breast cancer [J]. Breast Cancer Res Treat2023198(3):405-412.
[29]
Lee JPark HSLee H,et al. Axillary lymph node dissection using a robotic surgical system:initial experience [J]. J Surg Oncol2020122(6):1252-1256.
[30]
Lim SMKum CKLam FL. Nerve-sparing axillary dissection using the da vinci surgical system [J]. World J Surg200529(10):1352-1355.
[31]
Chen KBeeraka NMZhang J,et al. Efficacy of da vinci robot-assisted lymph node surgery than conventional axillary lymph node dissection in breast cancer - a comparative study [J]. Int J Med Robot202117(6):e2307.
[32]
陈阔,吕鹏威. 机器人辅助乳腺癌腋窝淋巴结清扫术的初步探索(附手术视频) [J]. 机器人外科学杂志(中英文)20256(2):349-354.
[33]
Li ZChen ZWei L,et al. Minimally invasive axillary lymph node dissection versus conventional axillary lymph node dissection:a comparative study on short-term efficacy in breast cancer [J]. Surg Endosc202539(8):4935-4945.
[34]
Wang QYang QChen Z,et al. Robot assisted sentinel lymph node biopsy using indocyanine green combined with carbon nanoparticles staining improved detection rates in breast cancer [J]. Sci Rep202515(1):21366.
[35]
Vanmulken JMSchols RMScharmga MJ,et al. First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema:a randomized pilot trial [J]. Nat Commun202011(1):757.
[36]
Gourd E. Robot-assisted supermicrosurgery for lymphoedema [J]. Lancet Oncol202021(3):e134.
[37]
Chen WFCheong CFTedone CE,et al. Robot-assisted lymph node-to-vein anastomosis:lessons from the first 22 cases at a high-volume lymphatic supermicrosurgery center [J]. Curr Oncol202532(7):377.
[38]
Vanmulken JMWolfs JQiu SS,et al. One-year outcomes of the first human trial on robot-assisted lymphaticovenous anastomosis for breast cancer-related lymphedema [J]. Plast Reconstr Surg2022149(1):151-161.
[39]
Vonreibnitz DWeinzierl ABarbon C,et al. 100 anastomoses:a two-year single-center experience with robotic-assisted micro- and supermicrosurgery for lymphatic reconstruction [J]. J Robot Surg202418(1):164.
[40]
刘跃,栾杰. 机器人辅助手术技术在乳房再造中的应用进展 [J]. 中华整形外科杂志202238(12):1414-1418.
[41]
陈阔,吕鹏威. 达芬奇机器人保留乳头乳晕的乳腺切除即刻假体乳房重建术的学习曲线研究 [J]. 中国现代普通外科进展202427(11):873-876.
[42]
徐静芬,普鹰,侯文婷,等. 成本控制视角下不同术种耗材用量及费用差异——以达芬奇机器人手术为例 [J]. 上海管理科学202345(2):84-87.
[43]
陈阔,吕鹏威. 达芬奇机器人保留乳头乳晕乳腺切除即刻假体乳房重建术中预防热蒸汽损伤皮肤组织临床研究 [J]. 中国修复重建外科杂志202438(7):813-817.
[44]
Chen KLu P. A simple approach to prevent skin damage from heat steam in robotic breast surgery [J]. Front Oncol202515:1580504.
[45]
Toesca APeradze NManconi A,et al. Robotic nipple-sparing mastectomy for the treatment of breast cancer:feasibility and safety study [J]. Breast201731:51-56.
[46]
陈阔,宋达疆,吕鹏威. 达芬奇机器人在保留乳头乳晕乳腺切除即刻假体乳房再造术中应用的效果探讨 [J]. 中华医学美学美容杂志202430(5):425-429.
[47]
Lai HWChen DRLiu LC,et al. Robotic versus conventional or endoscopic-assisted nipple-sparing mastectomy and immediate prosthesis breast reconstruction in the management of breast cancer:a prospectively designed multicenter trial comparing clinical outcomes,medical cost,and patient-reported outcomes (RCENSM-P) [J]. Ann Surg2024279(1):138-146.
[48]
Toesca ASangalli CMaisonneuve P,et al. A randomized trial of robotic mastectomy versus open surgery in women with breast cancer or BrCA mutation [J]. Ann Surg2022276(1):11-19.
[49]
Park KUTozbikian GHFerry D,et al. Residual breast tissue after robot-assisted nipple sparing mastectomy [J]. Breast202155:25-29.
[50]
Park HSLee JLai HW,et al. Surgical and oncologic outcomes of robotic and conventional nipple-sparing mastectomy with immediate reconstruction:international multicenter pooled data analysis [J]. Ann Surg Oncol202229(11):6646-6657.
[51]
陈阔,吕鹏威. 机器人与传统乳腺癌保留乳头乳晕皮下腺体切除即刻假体乳房重建术疗效对比研究 [J]. 中国实用外科杂志202444(11):1276-1280,1285.
[52]
Chen KLu P. Study of learning curve for da Vinci robotic nipple sparing mastectomy and immediate breast reconstruction with Gel implant [J]. Asian J Surg202548(6):3537-3543.
[53]
Houvenaeghe GBannier MRua S,et al. Breast cancer robotic nipple sparing mastectomy:evaluation of several surgical procedures and learning curve [J]. World J Surg Oncol201917(1):27.
[54]
Lai HWChen STTai CM,et al. Robotic-versus endoscopic-assisted nipple-sparing mastectomy with immediate prosthesis breast reconstruction in the management of breast cancer:a case-control comparison study with analysis of clinical outcomes,learning curve,patient-reported aesthetic results,and medical cost [J]. Ann Surg Oncol202027(7):2255-2268.
[55]
Lou ZJWu TYCheng FT. Evaluation of the learning curve in robotic nipple-sparing mastectomy for breast cancer [J]. Clin Breast Cancer202121(3):e279-e284.
[56]
Ryu JMKim JYChoi HJ,et al. Robot-assisted nipple-sparing mastectomy with immediate breast reconstruction:an initial experience of the Korea robot-endoscopy minimal access breast surgery study group(KoREa-BSG) [J]. Ann Surg2022275(5):985-991.
[57]
Lai HWToesca ASarfati B,et al. Consensus statement on robotic mastectomy-expert panel from international endoscopic and robotic breast surgery symposium (IERBS) 2019 [J]. Ann Surg2020271(6):1005-1012.
[58]
Kim JHRyu JMBae SJ,et al. Minimal access vs conventional nipple-sparing mastectomy [J]. JAMA Surg2024159(10):1177-1186.
[59]
Wan ALiang YChen L,et al. Association of long-term oncologic prognosis with minimal access breast surgery vs conventional breast surgery [J]. JAMA Surg2022157(12):e224711.
[60]
国际机器人乳腺外科手术专家协作组. 机器人乳腺癌手术专家共识 [J/OL] . 中华乳腺病杂志(电子版)202418(3):129-139.
[61]
陈阔,吕鹏威. 机器人辅助乳腺手术应用现状与发展趋势 [J]. 中国实用外科杂志202444(11):1317-1320.
[62]
Park HSLee JLee DW,et al. Robot-assisted nipple-sparing mastectomy with immediate breast reconstruction:an initial experience [J]. Sci Rep20199(1):15669.
[63]
Angarita FACastelo MEnglesakis M,et al. Robot-assisted nipple-sparing mastectomy:systematic review [J]. Br J Surg2020107(12):1580-1594.
[64]
王楠,孟元光. 5G远程机器人手术的发展与应用现状 [J]. 机器人外科学杂志(中英文)20256(3):503-507.
[1] 中华医学会超声医学分会, 中国研究型医院肿瘤介入治疗委员会, 中国妇幼保健协会乳腺保健专业委员会, 中华医学会肿瘤学分会乳腺癌专业委员会, 中国抗癌协会乳腺癌专业委员会, 中国人体健康科技促进会乳腺专业委员会. 无手术适应证乳腺癌消融治疗专家共识(2025版)[J/OL]. 中华乳腺病杂志(电子版), 2026, 20(01): 1-8.
[2] 深圳市医学会乳腺病学分会, 深圳市医学会肿瘤学分会, 深圳市医师协会乳腺专科医师分会, 深圳市健康管理协会乳房健康与康复管理专业委员会, 深圳市抗癌协会乳腺癌专业委员会, 深圳市抗癌协会肿瘤放射治疗专业委员会, 深圳市中西医结合学会甲状腺乳腺病专业委员会. 乳腺癌新辅助治疗的疗效预测和疗效评价专家共识(2025版)[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(06): 321-330.
[3] 李雨秋, 莫红楠. 乳腺癌肿瘤微环境特征及免疫治疗新进展[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(06): 331-338.
[4] 金烨莹, 王艺璇, 杨瑞. 基于单细胞RNA测序的乳腺癌肿瘤相关巨噬细胞亚群鉴定与临床预后分析[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(06): 339-347.
[5] 王天艺, 李筝, 许锐. 激素受体阳性/HER-2阴性早期乳腺癌的新辅助治疗[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(06): 352-357.
[6] 刘锦婷, 梁高强, 李文涛. 乳房切除术后感觉功能重建的研究进展[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(06): 358-361.
[7] 邓宝, 郭子琳, 仲雷. 乳腺癌治疗中的铁死亡机制与铁基纳米材料应用进展[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(06): 362-368.
[8] 樊晓宇, 刘风侠, 马力. 年轻乳腺癌患者养育忧虑的研究进展[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(06): 369-372.
[9] 谭路露, 李梦冉, 张晓莹, 唐立华, 谭宇彦. 原发性乳腺癌术后小肠转移一例[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(06): 373-376.
[10] 杨晶, 高洁, 李淑琴, 夏铀铀. 同时性双侧乳腺癌一例[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(06): 377-380.
[11] 罗仲燃, 曾智豪, 黄梦娟, 何晓艺. 乳腺癌术后腋窝淋巴结负荷的多因素分析及预测模型的建立及验证[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(01): 46-50.
[12] 王达, 朱建敏. 血小板/淋巴细胞计数比值对乳腺癌新辅助化疗疗效的预测效能[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 650-653.
[13] 马超, 王传嘉, 张武坊. 经腋窝入路单孔腔镜保乳术与传统开放手术治疗早期乳腺癌的对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 674-677.
[14] 彭鹏, 陈杰. 机器人手术在疝和腹壁外科领域国内外应用现状及展望[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(06): 638-644.
[15] 中国研究型医院学会微创外科学专业委员会, 中国研究型医院学会智能医学专业委员会, 中国医学装备协会智能装备技术分会. 腹腔镜(机器人)ICG荧光染色技术在肝恶性肿瘤切除术中的应用专家共识[J/OL]. 中华腔镜外科杂志(电子版), 2025, 18(06): 321-328.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?