Skip to main content

Advertisement

SpringerLink
Log in

A systematic review of robotic breast surgery versus open surgery

  • Review
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

Robotic-assisted breast surgery (RABS) is controversial. We systematically reviewed the evidence about RABS, comparing it to open conventional breast surgery (CBS). Following prospective registration (osf.io/97ewt), a search was performed in January 2023, without time or language restrictions, through bibliographic databases (PubMed, Web of Science, EMBASE, Scopus, Trip database and CDSR) and grey literature. Quality was assessed in duplicate using Qualsyst criteria (score range 0.0–1.0); reviewer agreement was 98%. The 16 selected studies (total patients: 334,804) had overall high quality (mean score 0.82; range 0.68–0.91). Nine of 16 (56.3%) were cohort studies, 2/16 (12.5%) RCTs, and 5/16 (31.3%) case–control studies. Taking p < 0.05 as the significance threshold, RABS versus CBS was better in aesthetic results and patient satisfaction (10/11 studies; 90%), was surgically costly (4/4 studies; 100%), time-consuming (9/13 studies; 69%), and less painful in the first 6–24 h (2/2 studies; 100%) and without statistically significant differences in complication rates (10/12 studies; 83%) or short-term oncological outcomes (10/10 studies; 100%). Surgical time could be dramatically reduced by training surgical teams, reaching no significant differences between approaches (p = 0.120). RABS was shown to be feasible and safe. The advantages of RABS and long-term outcomes need further research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and materials

The data and materials supporting the results are available from the corresponding author on reasonable request.

Abbreviations

ALND:

Axillary lymph node dissection

BC:

Breast cancer

BCRT:

Breast cancer research and treatment

CBS:

Conventional breast surgery

CCH:

Changhua Christian Hospital

CGMH:

Chang Gung Memorial Hospital

DIEP:

Deep inferior epigastric perforator

EABS:

Endoscopic assisted breast surgery

EIO:

European Institute of Oncology

JPRAS:

Journal of Plastic, Reconstructive & Aesthetic Surgery

MABS:

Minimal invasive/access breast surgery

MDACC:

MD Anderson Cancer Centre

n/a:

Not applicable

NRCT:

Non-randomised control trial

NS:

Not specified

NSM:

Nipple-sparing mastectomy

PCI:

Paoli Calmettes Institute

RABS:

Robotic-assisted breast surgery

RCT:

Randomised controlled trial

SSO:

Society of Surgical Oncology

SWH:

Southwest Hospital

UHCMC:

University Hospitals Cleveland Medical Centre

YUCM:

Yonsei University College of Medicine

ZSUH:

Zhengzhou and Sechenov University Hospitals

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424

    Article  PubMed  Google Scholar 

  2. World Health Organization (2019) Global Health Observatory. Geneva: World Health Organization; 2019. who.int/gho/database/en/. Accessed 3 Dec 2019

  3. Acebal BM, Alba CE, Alvarez BM, Bayo LE, Del Río US, Dotor GM (2011) Cáncer de mama proceso asistencial integrado. 3rd edn. Consejería de Salud, Sevilla

  4. Chan CWH, Law BMH, So WKW, Chow KM, Waye MMY (2017) Novel strategies on personalized medicine for breast cancer treatment: an update. Int J Mol Sci 18(11):2423

  5. Selber JC (2019) Robotic nipple-sparing mastectomy: the next step in the evolution of minimally invasive breast surgery. Ann Surg Oncol 26(1):10–11

    Article  PubMed  Google Scholar 

  6. Park HS, Lee JS, Lee JS, Park S, Kim SI, Park BW (2011) The feasibility of endoscopy-assisted breast conservation surgery for patients with early breast cancer. J Breast Cancer 14(1):52–57

    Article  PubMed  PubMed Central  Google Scholar 

  7. Toesca A, Invento A, Massari G, Girardi A, Peradze N, Lissidini G et al (2019) Update on the feasibility and progress on robotic breast surgery. Ann Surg Oncol 26(10):3046–3051

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lee MJ, Won J, Song SY, Park HS, Kim JY, Shin HJ et al (2022) Clinical outcomes following robotic versus conventional DIEP flap in breast reconstruction: a retrospective matched study. Front Oncol 12:989231

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kuo CSN, Sinelnikov M, Nassilevsky P, Reshetov I (2019) A case of breast surgery with da vinci si robotics. Revista Latinoamericana de Hipertension 14:70–73

    Google Scholar 

  10. Lai HW, Chen ST, Tai CM, Lin SL, Lin YJ, Huang RH et al (2020) 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. Ann Surg Oncol 27(7):2255–2268

    Article  PubMed  Google Scholar 

  11. Lai HW, Mok CW, Chang YT, Chen DR, Kuo SJ, Chen ST (2020) Endoscopic assisted breast conserving surgery for breast cancer: clinical outcome, learning curve, and patient reported aesthetic results from preliminary 100 procedures. Eur J Surg Oncol 46(8):1446–1455

    Article  PubMed  Google Scholar 

  12. Toesca A, Sangalli C, Maisonneuve P, Massari G, Girardi A, Baker JL et al (2022) A randomized trial of robotic mastectomy versus open surgery in women with breast cancer or BrCA mutation. Ann Surg 276(1):11–19

    Article  PubMed  Google Scholar 

  13. Administration) FUFaD (2021) UPDATE: Caution When Using Robotically- Assisted Surgical Devices in Women’s Health including Mastectomy and Other Cancer-Related Surgeries. FDA Safety Communication 2021. https://www.fda.gov/medical-devices/safety-communications/update-caution-robotically-assisted-surgical-devices-mastectomy-fda-safety-communication

  14. Lai HW, Chen ST, Mok CW, Lin YJ, Wu HK, Lin SL et al (2020) Robotic versus conventional nipple sparing mastectomy and immediate gel implant breast reconstruction in the management of breast cancer—a case control comparison study with analysis of clinical outcome, medical cost, and patient-reported cosmetic results. J Plast Reconstr Aesthet Surg 73(8):1514–1525

    Article  PubMed  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med 3(3):e123–e130

    PubMed  PubMed Central  Google Scholar 

  16. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151(4):W65-94

    Article  PubMed  Google Scholar 

  17. Sackett DLSS, Richardson WS, Rosenberg W, Haynes RB (2000) Evidence-based medicine: how to practice and teach EBM, 2nd edn. Churchill Livingstone Inc, Edinburgh, pp 173–177

    Google Scholar 

  18. Kmet LM LR, Cook LS (2004) Standard quality assessment criteria for evaluating primary research papers from a variety of fields. Alberta Heritage Foundation for Medical Research, Edmonton

  19. Lee L, Packer TL, Tang SH, Girdler S (2008) Self-management education programs for age-related macular degeneration: a systematic review. Australas J Ageing 27(4):170–176

    Article  PubMed  Google Scholar 

  20. Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15(2):155–163

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wan A, Liang Y, Chen L, Wang S, Shi Q, Yan W et al (2022) Association of long-term oncologic prognosis with minimal access breast surgery vs conventional breast surgery. JAMA Surg 157(12):e224711

    Article  PubMed  PubMed Central  Google Scholar 

  22. Winocour STS, Chu CK, Liu J, Clemens MW, Selber JC (2020) Comparing outcomes of robotically assisted latissimus dorsi harvest to the traditional open approach in breast reconstruction. Plast Reconstr Surg 148(4):661e-e662

    Google Scholar 

  23. Chen K, Beeraka NM, Zhang J, Reshetov IV, Nikolenko VN, Sinelnikov MY et al (2021) Efficacy of da Vinci robot-assisted lymph node surgery than conventional axillary lymph node dissection in breast cáncer—A comparative study. Int J Med Robot 17(6):2307

  24. Lai HW, Chen ST, Lin YJ, Lin SL, Lin CM, Chen DR et al (2021) Minimal access (endoscopic and robotic) breast surgery in the surgical treatment of early breast cancer-trend and clinical outcome from a single-surgeon experience over 10 years. Front Oncol 11:739144

    Article  PubMed  PubMed Central  Google Scholar 

  25. Cao L, Shenk R, Miller ME, Towe C (2022) Minimally invasive mastectomy could achieve non-inferior oncological outcome in appropriately selected patients: propensity matched analysis of the national cancer database. Am Surg 88(12):2893–2898

    Article  PubMed  Google Scholar 

  26. Lee J, Park HS, Lee H, Lee DW, Song SY, Lew DH et al (2020) Post-operative complications and nipple necrosis rates between conventional and robotic nipple-sparing mastectomy. Front Oncol 10:594388

    Article  PubMed  Google Scholar 

  27. Moon J, Lee J, Lee DW, Lee HS, Nam DJ, Kim MJ et al (2021) Postoperative pain assessment of robotic nipple-sparing mastectomy with immediate prepectoral prosthesis breast reconstruction: a comparison with conventional nipple-sparing mastectomy. Int J Med Sci 18(11):2409–2416

    Article  PubMed  PubMed Central  Google Scholar 

  28. Houvenaeghel G, Barrou J, Jauffret C, Rua S, Sabiani L, Van Troy A et al (2021) Robotic versus conventional nipple-sparing mastectomy with immediate breast reconstruction. Front Oncol 11:637049

    Article  PubMed  PubMed Central  Google Scholar 

  29. Huang JJ, Chuang EY, Cheong DC, Kim BS, Chang FC, Kuo WL (2021) Robotic-assisted nipple-sparing mastectomy followed by immediate microsurgical free flap reconstruction: feasibility and aesthetic results—case series. Int J Surg 95:106143

    Article  PubMed  Google Scholar 

  30. Gui Y, Chen Q, Li S, Yang X, Liu J, Wu X et al (2022) Safety and feasibility of minimally invasive (laparoscopic/robotic-assisted) nipple-sparing mastectomy combined with prosthesis breast reconstruction in breast cancer: a single-center retrospective study. Ann Surg Oncol

  31. Park HS, Lee J, Lai HW, Park JM, Ryu JM, Lee JE et al (2022) Surgical and oncologic outcomes of robotic and conventional nipple-sparing mastectomy with immediate reconstruction: international multicenter pooled data analysis. Ann Surg Oncol 29(11):6646–6657

    Article  PubMed  Google Scholar 

  32. Houvenaeghel G, El Hajj H, Schmitt A, Cohen M, Rua S, Barrou J et al (2020) Robotic-assisted skin sparing mastectomy and immediate reconstruction using latissimus dorsi flap a new effective and safe technique: a comparative study. Surg Oncol 35:406–411

    Article  PubMed  Google Scholar 

  33. Houvenaeghel GRS, Barrou J, Van-Troy A, Knight S, Cohen M, Bannier M (2021) Robotic versus conventional latissimus dorsi-flap harvested for immediate breast reconstruction. J Surg Res 4(4):749-764

  34. Maharaj S, Harding R (2016) The needs, models of care, interventions and outcomes of palliative care in the Caribbean: a systematic review of the evidence. BMC Palliat Care 15:9

    Article  PubMed  PubMed Central  Google Scholar 

  35. Mok CW, Lai HW (2019) Evolution of minimal access breast surgery. Gland Surg 8(6):784–793

    Article  PubMed  PubMed Central  Google Scholar 

  36. Clair KH, Tewari KS (2020) Robotic surgery for gynecologic cancers: indications, techniques and controversies. J Obstet Gynaecol Res 46(6):828–843

    Article  PubMed  PubMed Central  Google Scholar 

  37. Zingg U, McQuinn A, DiValentino D, Esterman AJ, Bessell JR, Thompson SK et al (2009) Minimally invasive versus open esophagectomy for patients with esophageal cancer. Ann Thorac Surg 87(3):911–919

    Article  PubMed  Google Scholar 

  38. Cuellar-Gomez H, Rusli SM, Ocharan-Hernandez ME, Lee TH, Piozzi GN, Kim SH et al (2022) Operative and survival outcomes of robotic-assisted surgery for colorectal cancer in elderly and very elderly patients: a study in a Tertiary Hospital in South Korea. J Oncol 2022:7043380

    Article  PubMed  PubMed Central  Google Scholar 

  39. FUFaDA (2019) Caution When Using Robotically- Assisted Surgical Devices in Women’s Health including Mastectomy and Other Cancer-Related Surgeries. FDA Safety Communication. Accessed: 23 Aug 2023 https://www.fda.gov/news-events/fda-brief/fda-brief-fda-cautions-patients-providers-about-using-robotically-assisted-surgical-devices

  40. De la Cruz-Ku G, Chambergo-Michilot D, Perez A, Valcarcel B, Pamen L, Linshaw D et al (2023) Outcomes of robotic nipple-sparing mastectomy versus conventional nipple-sparing mastectomy in women with breast cancer: a systematic review and meta-analysis. J Robot Surg 17(4):1493–1509

    Article  PubMed  Google Scholar 

  41. Pp R (2018) Robotic surgery: new robots and finally some real competition! World J Urol 4:537–541

    Google Scholar 

Download references

Acknowledgements

KSK is a distinguished investigator at the University of Granada funded by the Beatriz Galindo (senior modality) program of the Spanish Ministry of Education.

Funding

This systematic review was not funded.

Author information

Authors and Affiliations

  1. Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario de Ourense, Calle Ramon Puga Noguerol, 54, 32005, Ourense, Spain

    Marta Maes-Carballo, Manuel García-García & Claudia Alberca-Remigio

  2. Hospital Público de Verín, Ourense, Spain

    Marta Maes-Carballo

  3. Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain

    Marta Maes-Carballo & Khalid Saeed Khan

  4. Department of General Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain

    Marta Maes-Carballo, Manuel García-García & Iago Rodríguez-Janeiro

  5. Department of Urology, Complexo Hospitalario de Ourense, Ourense, Spain

    Cristina Cámara-Martínez

  6. CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain

    Khalid Saeed Khan

Authors
  1. Marta Maes-Carballo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manuel García-García
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Iago Rodríguez-Janeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cristina Cámara-Martínez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claudia Alberca-Remigio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Khalid Saeed Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MMC conceived the work. MMC, IRJ, CCM and CAR compiled and analysed the data for the systematic review. MMC and IRJ interpreted the data. MMC wrote the first version of the draft. KSK and MGG edited the work critically for important academic content. KSJ directed the work. All authors consented to the final version of the manuscript. They agreed to be responsible for all elements of the review, providing those questions related to the accuracy or integrity of any part of the work were appropriately investigated and solved.

Corresponding author

Correspondence to Marta Maes-Carballo.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maes-Carballo, M., García-García, M., Rodríguez-Janeiro, I. et al. A systematic review of robotic breast surgery versus open surgery. J Robotic Surg 17, 2583–2596 (2023). https://doi.org/10.1007/s11701-023-01698-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-023-01698-5

Keywords

Search

Navigation