Robotics Breast Cancer surgery in Delhi NCR India

About Robotics in breast Cancer surgery

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Functional Breast

The present era of Breast Surgery is having functional breast after breast cancer treatment.

• Functionality of breast depends on the amount original skin and nipple preserved after removal of cancer.
• The surgical procedure is termed as Skin Sparing / Nipple Sparing resections. It involves removal of breast or partial removal of the suspicious malignant tissue with adequate margins preserving the overlying breast skin and nipple as well; if possible and reconstructing the defect with autologous tissue or prosthetic implant

Patients eligible for Robot Assisted Functional Breast Preservation (RAFBPS)

• Early stage breast cancers when tumor size is around 5 cm; overlying skin and muscle is not involved
• In Advanced Breast cancers, now the standard of care is Neo Adjuvant Systemic Thera[y which may be
  • a. Chemotherapy
  • b. Chemotherapy + Targetted Therapy/Immunotherapy
  • c. Hormonal Therapy

Patient who respond well to Neo Adjuvant Treatment become eligible for SSM/NSM

Skin Sparing / Nipple Sparing resections(SSM/ NSM) provide at par cancer control when compared with Radical Mastectomy in patients

Advantages of Robotic Assistance

Robotic Assistance helps provide even better results and breast functionality while doing SSM / NSM procedures

According to Dr Toesca etal from Milan who has one of the largest experiences of using Robotic assistance to perform Skin sparing / Nipple sparing procedures

There are substantial advantages of using Robotic Assistance:

• Robotic arms provide better access at angles which is not possible with retractors in open methodology
• Enhanced Vision leads to precision dissection
• Incision placement is generally in skin creases like axillary(lateral) or inferior mammary creases given superior aesthetics than conventional Skin sparing procedures
• Skin flap Vascularity is better preserved by minimizing counter traction and incision planning

Lateral Mammary Crease Access through Robot

Circumareolar Access through Robot

Reconstruction of Breast defects:

Oncoplastic Breast Preservation defines reconstructing the Breast Defect either by Volume Displacement i.e., reshaping and realigning remaining breast tissue to form the Neo Breast or Volume Replacement i.e.; harvesting tissues from back, abdomen, thigh etc and bringing them to fill the breast defect which may be complete or partial mastectomy defect.

Latissimus tissue (LD flap) from lateral and posterior back area is the work horse flap used in Volume Replacement Oncoplasty. To harvest the LD flap via conventional methodology a long incision is placed in the back, the patient has to be repositioned and redraped majority of times.

Robotic assistance provides:

• 1. Access to back(thorax) through axilla thus avoiding the incision and scar at the back, removing the need to reposition and redrape.
• 2. The advantages robotic assistance in form of 3D – magnified view and resolution; improved ergonomics; better access to thorax provided by robotic arms helps in making the surgical procedure much simpler

Seiber et al suggested Robotic assistance decreases surgical time to half and also avoided the posterolateral thoracic i.e., back scar

Fourage et al confirmed Robot Assisted LD Flap to be a safe and effective procedure which offers precise dissection with minimal scarring.

1. Robot being docked through axillary incision

2. Latissimus tissue dissection through robot

3. Latissimus tissue mobilized into axilla and breast defect

Final Result after RAFBPS