Domestic single-port snake-arm robot in transaxillary nipple-sparing mastectomy with immediate prepectoral implant-based breast reconstruction

doi:10.3877/cma.j.issn.1674-0807.2026.05.005

Abstract

Abstract:

Objective

To evaluate the feasibility and short-term safety of domestic single-port snake-arm robot in transaxillary robot-assisted nipple-sparing mastectomy combined with immediate prepectoral implant breast reconstruction (rNSM+IBR) .

Methods

A prospective study enrolled on the clinical data of 23 breast cancer patients who underwent rNSM+IBR from March 2025 to April 2026, including 9 patients in the Huashan Hospital, Fudan University and 14 patients in the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine. The following parameters were recorded: pathological findings, surgical procedures, operative duration, and perioperative complications.Primary endpoints were surgical feasibility and early postoperative safety;secondary outcomes included operative parameters, postoperative recovery, and learning-curve characteristics. The cumulative sum (CUSUM) curve was adopted to characterize the surgeon's learning curve.

Results

All 23 patients successfully completed the procedure via transaxillary incision, without conversion to open surgery or additional incisions. The operative time was 260 (170, 290) min. No Clavien-Dindo grade Ⅲ or higher complications occurred within 30 days postoperatively. No skin flap necrosis, nipple-areolar complex necrosis, severe infection, or prosthetic displacement was observed. Operative time decreased with experience, and the CUSUM analysis confirmed a stable learning curve within 10 cases.

Conclusion

The use of domestic single-port snake-arm robot is feasible and safe for transaxillary rNSM+IBR, with favorable perioperative profiles and a manageable learning curve.

Key words: Breast neoplasms, Single-port robotic surgery, Nipple-sparing mastectomy, Breast reconstruction, Learning curve

Wei Zhang, Min Wei, Xiaoding Jin, Chengyu Chu, Yongzhe Tang, Jie Wang, Yiting Jin. Domestic single-port snake-arm robot in transaxillary nipple-sparing mastectomy with immediate prepectoral implant-based breast reconstruction[J]. Chinese Journal of Breast Disease(Electronic Edition), 2026, 20(05): 291-296.

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URL: https://zhrxbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0807.2026.05.005

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References 29

［1］	Nodiţi A，Sarfati B，Peleaşă TM，et al. The first Romanian robotic-assisted mastectomy：a starting point for a literature review［J］. Chirurgia（Bucur），2024，119（5）：500-514.
［2］	Maes-Carballo M， Gómez-Fandiño Y， Braña PMS， et al. Robotic nipple-sparing mastectomy： a comparative analysis with conventional and endoscopic techniques through a systematic review［J］. J Rob Surg， 2025， 19（1）： 220.
［3］	Lee J，Go J，Lee SJ，et al. Comparative study of mastectomy using conventional techniques，multiport and single-port robotic surgical systems［J］. Cancer Res Treat，2026，58（2）：492-500.
［4］	Lai HW，Su J，Abdul Rauf NH，et al. Long-term oncologic outcomes of minimal access（endoscopic or Robotic Assisted）nipple-sparing mastectomy compared with conventional approach in breast cancer - a propensity score matching analysis［J］. Int J Surg，2025，112（4）：9927-9946.
［5］	Sarfati B，Toesca A，Roulot A，et al. Transumbilical single-port robotically assisted nipple-sparing mastectomy：a cadaveric study［J］. Plast Reconstr Surg Glob Open，2020，8（5）：e2778.
［6］	Wo LM，Kuo WL，Cheong DC. Robot-assisted mastectomy and immediate microsurgical breast reconstruction［J］. Semin Plast Surg，2026，40（1）：83-88.
［7］	Park HS，Kim JH，Lee DW，et al. Gasless robot-assisted nipple-sparing mastectomy：a case report［J］. J Breast Cancer，2018，21（3）：334-338.
［8］	Toesca A，Peradze N，Galimberti V，et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with implant：first report of surgical technique［J］. Ann Surg，2017，266（2）：e28-e30.
［9］	Sarfati B，Honart JF，Leymarie N，et al. Robotic da Vinci Xi-assisted nipple-sparing mastectomy：first clinical report［J］. Breast J，2018，24（3）：373-376.
［10］	Lai HW，Chen ST，Lin SL，et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with gel implant：technique，preliminary results and patient-reported cosmetic outcome［J］. Ann Surg Oncol， 2019， 26（1）：42-52.
［11］	Go J，Ahn JH，Park JM，et al. Analysis of robot-assisted nipple-sparing mastectomy using the da Vinci SP system［J］. J Surg Oncol，2022，126（3）：417-424.
［12］	Lee JH. Cutting-edge trends in da Vinci single-port robotic approaches to breast surgery：a narrative review［J］. Ann Surg Treat Res，2026，110（1）：12-18.
［13］	Park KU，Cha C，Pozzi G，et al. Robot-assisted nipple sparing mastectomy：recent advancements and ongoing controversies［J］. Curr Breast Cancer Rep，2023，15（2）：127-134.
［14］	Kim CW，Yoo TK，Kim J，et al. Postoperative outcomes of single-port robot-assisted versus conventional nipple-sparing mastectomy with immediate reconstruction［J］. Ann Surg Oncol，2026，33（3）：2246-2254.
［15］	Nessa A，Shaikh S，Fuller M，et al. Postoperative complications and surgical outcomes of robotic versus conventional nipple-sparing mastectomy in breast cancer：meta-analysis［J］. Br J Surg，2024，111（1）：znad336.
［16］	Joo OY，Song SY，Lew DH，et al. Robotic harvest of a latissimus dorsi flap using a single-port surgical robotic system in breast reconstruction［J］. Arch Plast Surg，2021，48（6）：577-582.
［17］	Ahn SJ，Song SY，Park HS，et al. Early experiences with robot-assisted prosthetic breast reconstruction［J］. Arch Plast Surg，2019，46（1）：79-83.
［18］	Ouyang R，Jia X，Liang Y，et al. Single-port robotic nipple-sparing mastectomy：a systematic review and single-arm meta-analysis of safety and process outcomes［J］. J Robotic Surg，2025，20（1）：106.
［19］	Lee SB，Kim J，Chung IY，et al. Use of the da Vinci SP surgical system in robot-assisted nipple-sparing mastectomy：a single-center，retrospective study［J］. Sci Rep，2025，15（1）：12.
［20］	Joo OY，Song SY，Park HS，et al. Single-port robot-assisted prosthetic breast reconstruction with the da Vinci SP surgical system：first clinical report［J］. Arch Plast Surg，2021，48（2）：194-198.
［21］	Choi JE，Lee YW，Gwark S，et al. Single-port robot-assisted nipple-sparing mastectomy：main analysis of a retrospective multicenter study （SPROUT，KoREa-BSG 09）［J］. Ann Surg Oncol，2026，33（6）： 5533-5540.
［22］	Lai HW，Chen ST，Tai 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 Oncol，2020，27（7）：2255-2268.
［23］	Jung SM，Kim YJ，Lee KT，et al. Learning curve for robot-assisted nipple-sparing mastectomy：a single institution experience［J］. Eur J Surg Oncol，2024，50（10）：108602.
［24］	Houvenaeghel G，Bannier M，Rua S，et al. Breast cancer robotic nipple sparing mastectomy：evaluation of several surgical procedures and learning curve［J］. World J Surg Oncol，2019，17（1）：27.
［25］	Gwark S，Hwang YH，Paek SH，et al. Early postoperative outcomes of tumescent-free single-port robot-assisted nipple-sparing mastectomy compared with tumescent-using technique：a substudy of retrospective multicenter study（SPROUT，KoREa-BSG 14）［J］. Ann Surg Oncol，2025，32（13）：9787-9797.
［26］	Hwang YH，Han HH，Eom JS，et al. Evaluation of safety and operative time in tumescent-free robotic nipple-sparing mastectomy：a retrospective single-center cohort study［J］. Ann Surg Treat Res，2024，107（1）：8-15.
［27］	Haddock NT，Teotia SS，Farr D. Robotic nipple-sparing mastectomy and breast reconstruction with profunda artery perforator flaps［J］. Plast Reconstr Surg，2025，156（3）：337e-341e.
［28］	Ostapenko E，Nixdorf L，Devyatko Y，et al. Prepectoral versus subpectoral implant-based breast reconstruction：a systemic review and meta-analysis［J］. Ann Surg Oncol，2023，30（1）：126-136.
［29］	Kim JH，Toesca A，Pozzi G，et al. Controversies and strengths of robot-assisted mastectomy［J］. Eur J Cancer Prev，2023，32（4）：388-390.

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