Editor’s Note: The prevalence of robotic surgery in the treatment of early-stage breast cancer is not high, and there is significant debate over its necessity for these patients. At the 2024 South-North Forum, Prof. Li Ma from The Fourth Hospital of Hebei Medical University delivered a presentation on the topic “Is Robotic Surgery Necessary for Early-Stage Breast Cancer?” This article reviews the key points from his lecture.

Current Status of Robotic Surgery in Breast Cancer

Robotic surgery systems mainly refer to robotic laparoscopic surgery systems. Compared to traditional laparoscopic surgery, robotic surgery systems offer notable advantages, including high-definition 3D imaging magnified several times, seven degrees of freedom in mechanical arm movement, and remote operation capabilities. Due to these characteristics, recent literature suggests that robotic surgery is more suitable for operations in narrow and deep spaces, with general surgery (18%), gynecology, obstetrics, and orthopedics being the primary areas of application.

In the field of breast surgery, robotic laparoscopic surgery offers several advantages over traditional laparoscopic surgery: improved aesthetics (leading to higher physical and mental satisfaction and quality of life), reduced incidence of certain complications, minimized tissue damage, facilitation of operations difficult to perform with traditional laparoscopy, and the ability to conduct remote surgeries. Despite these advantages, not all breast-related surgeries are suitable for robotic execution, leading to its limited application in the breast surgery field. Robotic surgery mainly involves procedures such as breast reconstruction, gynecomastia treatment, lymph node dissection, and microsurgery.

Robotic laparoscopic surgery in breast cancer also has some disadvantages, such as high costs, limited applicability, lack of tactile feedback, long learning curve, extended operation times for some procedures, spatial constraints, and a lack of customized instruments specific to breast surgery. Additionally, due to its relatively recent introduction and the small number of breast cancer patients undergoing this type of surgery, there is a lack of long-term follow-up data.

Regarding complications, previous research indicates that robot-assisted nipple-sparing mastectomy (RNSM) may reduce the rate of nipple-areolar complex (NAC) necrosis compared to conventional nipple-sparing mastectomy (CNSM). This can be attributed to two main factors: the smaller axillary or lateral incision in RNSM is more conducive to maintaining blood supply to the nipple, and it provides better visualization. However, some studies report no statistically significant difference in NAC necrosis rates between RNSM and CNSM. Moreover, there is no significant difference in the types and rates of perioperative complications between the two procedures.

In terms of surgical trauma, robotic surgery’s advantages in more complex operations include smaller incisions and greater flexibility. However, aside from using the Da Vinci SP single-port laparoscopic surgery system (SP system), robotic surgery typically requires several mechanical arms working together, necessitating more trocar ports. Although the SP system can perform single-port operations, it has weaker grasping ability and higher reverse pullback rates, which can increase surgical difficulty.

Prof. Ma highlighted that remote operation is considered a unique advantage of robotic surgery, allowing patients to receive medical services across geographical barriers and addressing the issue of inadequate medical resources in remote areas to some extent. However, practical challenges include the low prevalence of surgical robots in China, the shortage of professionally trained personnel to operate these devices, and the high costs associated with purchasing, maintaining, and operating the equipment, as well as the costs of consumables, which are not yet covered by insurance. These factors impose a significant financial burden on many patients. Therefore, Prof. Ma concluded that although robotic surgery holds potential, its widespread promotion in the field of breast surgery is currently not advisable.

Perspectives on the Development of Robotic Breast Surgery

Prof. Ma discussed the current trends in robotic breast surgery development, noting ongoing debates. The short duration of robotic surgery application, the limited number of patients, and the lack of long-term follow-up data mean that its oncological safety needs further validation. Additionally, robotic breast surgery has not yet received approval from the FDA and NMPA, leading to a lack of regulatory oversight in clinical applications. Recent literature reports indicate that robotic surgery systems do not show significant advantages over traditional surgery.

In his concluding remarks, Prof. Ma stated that robotic surgery cannot replace open surgery and traditional laparoscopic surgery; each method has its pros and cons. The choice of surgical method should be based on the comprehensive evaluation of the patient’s condition rather than an exclusive preference for any particular technique. The minimally invasive and precise nature of robotic surgery aligns with the development direction of breast surgery, and its future promotion and application remain hopeful, depending on further technological advancements and improvements in equipment and instruments.

Prof. Li Ma

– Chief Physician, Professor, PhD, Postdoctoral Fellow at the Third Military Medical University

– Doctoral Supervisor

– Director of the Breast Center Ward, Fourth Hospital of Hebei Medical University

– Member of the Breast Cancer Professional Committee of the Chinese Anti-Cancer Association

– Member of the Breast Cancer Expert Committee of the Chinese Society of Clinical Oncology (CSCO)

– Standing Member of the Breast Disease Professional Committee of the China Medical Education Association

– Deputy Secretary-General of the Hebei Province Cancer Prevention and Treatment Union

– Chairman-elect of the Breast Cancer Professional Committee of the Hebei Province Cancer Prevention and Treatment Union

– Chairman-elect of the Breast Cancer Expert Committee of the Hebei Province Clinical Oncology Society

– Standing Member of the Breast Cancer Professional Committee of the Hebei Anti-Cancer Association

– Chairman of the Youth Committee of the Breast Cancer Professional Committee of the Hebei Anti-Cancer Association