Search Results (31)

Background and Objectives: Breast reconstruction after mastectomy has been shown to significantly improve psychosocial wellbeing and quality of life. Enhanced Recovery After Surgery (ERAS) protocols, especially those tailored to breast reconstruction, have revolutionized recovery by reducing complications, pain, opioid use, and hospital stay while improving patient satisfaction. The purpose of this narrative review was to present existing practices and supporting evidence within current ERAS protocols, as well as propose a modern ERAS framework centered around enhancing the patient experience following breast reconstruction. Methods: A focused literature search was conducted to identify studies investigating emerging approaches to patient care and surgical techniques adopted as part of a broader ERAS workflow Results: Some recent innovations include digital ERAS tracking, robot-assisted techniques, neurotization, and closed incision negative pressure therapy (ciNPT). These innovations show promise in reducing morbidity following reconstruction and may greatly improve sensory and functional outcomes. These advancements also reflect a shift toward more holistic, patient-centered care, extending beyond immediate clinical needs to address long-term wellbeing through psychosocial support and patient-reported outcome measures. Incorporating tools that validate patient perspectives helps guide interventions to optimize satisfaction and recovery. Conclusions: Future research should aim to standardize ERAS protocols by incorporating evidence-based practices, reinforcing breast reconstruction as a patient-centered, evidence-driven process that is focused on comprehensive recovery and improved quality of life. Full article

Background: Robotic deep inferior epigastric artery perforator (DIEP) flap surgery is a technique used for autologous breast reconstruction to maintain the integrity of the rectus abdominis muscle while also utilizing robotic assistance for flap harvest. This study assesses postoperative outcomes of patients undergoing robotic DIEP flap reconstruction through the measurement of postoperative pain, narcotics use, and antiemetic usage. Methods: A retrospective analysis was performed for patients undergoing robotic DIEP flap breast reconstruction between March 2024 and March 2025. Postoperative pain scores (1–10 scale), narcotics usage (measured in oral morphine equivalents), antiemetic usage, and complications were recorded. Patient outcomes were compared to a control group of 40 patients who had undergone abdominal-based free flap breast reconstruction. Results: Overall, 14 patients underwent robotic DIEP flap breast reconstruction, representing 24 breasts. The average patient age was 56.5 (range: 30–73). Ten patients underwent bilateral breast reconstruction, and four underwent unilateral breast reconstruction. The average length of stay postoperatively was 4.86 days (±1.23 days), and the return of bowel function occurred in 1.29 days (±0.47 days). No patients experienced an unplanned return to the OR or flap failure. Average pain scores on postoperative day 1 (POD1), 2 (POD2), and 3 (POD3) were 4.0 (±0.6), 3.4 (±0.6), and 2.93 (±0.5), respectively. Average antiemetic usage totalled 1.25 doses (±0.25). Average daily OME use was 27.7 (±5.0) for POD1, 25.96 (±6.3) for POD2, and 21.23 (±7.11) for POD3. This averaged to a total hospital OME use of 74.9 (±15.7) per patient. Patients undergoing robotic DIEP flap reconstruction required a significantly lower narcotics dosage, as well as a lower antiemetic dosage, during the first three days postoperatively compared to the control abdominal free flap group. Average pain scores in the robotic DIEP flap reconstruction patient group were also significantly decreased, specifically in POD2 and POD3. Conclusions: The robotic DIEP flap offers advantages in autologous breast reconstruction compared to other abdominal free flap reconstructive methods. In this limited retrospective study, the use of the robotic DIEP flap lowers chances of flap failure and complications, while also improving narcotics use, antiemetic use, and postoperative pain. Full article

Background: Breast cancer is a widespread disease and, when metastatic, has a bleak prognosis. The surgical approach for BCLM has had a limited role, but robotic surgery could find an important place. Methods: Data were collected from a multicenter retrospective database that includes 1070 consecutive robotic liver resections performed in nine European hospital centers from 2011 to 2023. Of the entire series, 35 were performed for BCLM in five European hospital centers. Results: The post-operative complication rate was 11.44%, but no severe complications occurred. The mean hospital stay was 4.65 days. One patient (2.85%) was readmitted to the hospital within 90 days after discharge and died due to heart failure, with a 90-day mortality of 2.85%. Conclusions: Robotic liver resection for BCLM is feasible and safe when performed in experienced centers by surgeons who have completed the learning curve. Full article

Background/Objectives: The aim of this case series is to evaluate the outcomes and safety of video-assisted mastectomy, illustrating the harmonious collaboration of oncologic and plastic surgery. This novel minimally invasive technique allows immediate prosthetic reconstruction and represents a cost-effective alternative to robotic breast surgery. Methods: Video-assisted, single-port nipple-sparing mastectomies were performed in patients with small to medium-sized breasts, followed by immediate direct-to-implant reconstruction with either prepectoral or dual plane implant placement. The patients’ electronic medical records were analyzed, including demographic characteristics, operative times and histopathology reports. Results: A total of 18 patients underwent successful video-assisted mastectomy, without conversion to traditional open procedure. Fifteen of the operations were risk-reducing mastectomies. Twelve patients had complementary procedures performed concurrently on the previously operated contralateral breast (delayed reconstruction/expander-to-implant exchange). Moreover, three patients benefited from additional minimally invasive techniques during the same surgery (prophylactic laparoscopic hysterectomy). Immediate breast reconstruction with polyurethane or microtextured breast implants up to 450 cc was performed, with satisfactory aesthetic outcomes and no cancer recurrences at 6 to 12 months postoperative follow-up. Early complications included transient hypercapnia, areolar congestion and cellulitis. No skin necrosis or implant-related complications were reported. The most frequently encountered late issues were contour irregularities. Conclusions: Video-assisted mastectomy facilitates the safe removal of proven pathologic or healthy breast tissue with minimal damage to the breast’s skin envelope, facilitating single-stage breast reconstruction. Full article

Background: A surgical therapy for breast cancer, robot-assisted nipple-sparing mastectomy (RANSM) has gained popularity because it may offer better cosmetic results than traditional nipple-sparing mastectomy (CNSM). Data regarding RANSM’s viability and security are still scarce, nevertheless. Comparing the surgical results of RANSM and CNSM in a single-center experience was the goal of this study. Methods: 57 patients who had nipple-sparing mastectomy procedures performed at our facility between January and December 2021 were included in this retrospective research. Of them, 49 patients had CNSM, and 8 patients had RANSM. Analysis was performed on pain scores, length of hospital stay, postoperative complications, patient demographics, and operating time. Results: The mean total operative time was longer for RANSM group was 148 min compared to 117 min for the CNSM group; however, this difference was not statistically significant (p = 0.083). The mean duration of hospital stay was shorter for the RANSM group than for the CNSM group (10.75 days vs. 2.92 days, respectively; p = 0.302). Both groups had similar pain scores on postoperative day 3 (RANSM: 3.50, CNSM: 3.54, p = 0.926). No patient in the RANSM group received adjuvant chemotherapy or radiotherapy, whereas 32.6% of patients in the CNSM group received chemotherapy. The RANSM and CNSM groups experienced complications at rates of 12.5% and 18.4%, respectively (p = 0.571). In contrast to 14.3% in the CNSM group, there were no documented incidences of skin necrosis in the RANSM group. Conclusions: RANSM demonstrated comparable safety to CNSM with potential benefits, including a shorter hospital stay and lower complication rates. These findings support the feasibility of RANSM, particularly in patients prioritizing cosmetic outcomes. To validate these initial findings, more research with larger cohorts and longer follow-up times is necessary. Full article

Background and Objectives: After introducing the single-port robotic surgical system (da-Vinci SP), thyroid surgeries using da-Vinci SP are becoming more popular. Although many methods have been designed for thyroidectomy using the da-Vinci SP, there are very few reports on methods that can perform not only thyroidectomy but also lateral cervical lymph node dissection. In this study, we want to report the first clinical experience with SPRA-MRND (Single Port Robotic Areolar-Modified Radical Neck dissection), using right breast access. Materials and Methods: From April 2024 to January 2025, a total of 24 robotic MRNDs were performed, of which 11 were SPRA-MRNDs. The remaining 13 were performed using conventional BABA surgery. The two data sets were compared through retrospective medical record analysis. Results: There were no significant differences regarding patient characteristics, pathologic variables and oncologic outcomes between the two groups. However, SPRA group showed significantly shorter operation time (182.1 ± 27.5 vs. 213.1 ± 31.5 min, p = 0.017), higher immediate postoperative calcium level (calcium: 8.7 ± 0.5 vs. 8.0 ± 0.8 mg/dL, p = 0.014) and lower drainage amount (98.1 ± 33.2 vs. 146.4 ± 43.2 mL, p = 0.005). Conclusions: Our initial experience has shown that SPRA-MRND is performed safely. We propose SPRA-MRND as a good method for minimally invasive robotic surgery. Full article

To achieve obstacle-avoiding puncture in breast interventional surgery, a robotics system based on three-fingered breast target-point manipulation is proposed and designed. Firstly, based on the minimum number of control points required for three-dimensional breast deformation control and the bionic structure of the human hand, the structure and control scheme of the robotics system based on breast target-point manipulation are proposed. Additionally, the workspace of the robotics system is analyzed. Then, an optimal control point selection method based on the minimum resultant force principle is proposed to achieve precise manipulation of the breast target point. Concurrently, a breast soft tissue manipulation framework incorporating a Model Reference Adaptive Control (MRAC) system is developed to enhance operational accuracy. A dynamic model of breast soft tissue is developed by using the manipulative force–displacement data obtained during the process of manipulating breast soft tissue with mechanical fingers to realize the manipulative force control of breast tissue. Finally, through simulation and experiments on breast target-point manipulation tasks, the results show that this robotic system can achieve spatial control of breast positioning at arbitrary points. Meanwhile, the robotic system proposed in this study demonstrates high-precision control with an accuracy of approximately 1.158 mm (standard deviation: 0.119 mm), fulfilling the requirements for clinical interventional surgery in target point manipulation. Full article

Background: Robotic surgical systems offer enhanced precision, motion scaling, tremor filtration, and visualization, making them highly suitable for the complex anatomical demands of plastic and reconstructive surgery. While widely implemented in other specialties, their integration in plastic surgery remains limited. This systematic review evaluates the clinical applications, outcomes, and limitations of robotic-assisted techniques in plastic and reconstructive procedures. Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Embase, Scopus, and Web of Science for studies published between January 1980 and March 2025. Clinical studies reporting robotic applications in plastic surgery were included, while cadaveric, animal, and non-English studies were excluded. Data extraction and quality assessment were performed using Covidence and validated tools including the CARE checklist, NOS, GRADE, and SYRCLE. A total of 1428 studies were screened, and 31 met the inclusion criteria. Results: Robotic systems were primarily applied in microsurgery (n = 16), breast reconstruction (n = 8), and craniofacial/aesthetic surgery (n = 7). Common platforms included the Symani Surgical System, Da Vinci systems, and ARTAS. Robotic-assisted approaches improved precision, aesthetic outcomes, flap survival, and patient satisfaction, particularly in procedures involving lymphaticovenous anastomosis and nipple-sparing mastectomy. However, challenges included steep learning curves, longer operative times, high equipment costs, and the lack of haptic feedback. Quality assessment rated all studies as moderate. Conclusions: Robotic-assisted surgery demonstrates considerable potential in enhancing plastic and reconstructive outcomes. As systems become more compact, cost-effective, and integrated with AI and biomimetic technologies, their broader adoption is anticipated. Further high-quality studies are needed to optimize these systems and support widespread clinical implementation. Full article

Background: Autologous breast reconstruction has undergone a remarkable evolution, driven by the pursuit of addressing past concerns primarily related to donor site morbidity and complication risks. Improved techniques now prioritize minimizing invasiveness, complications, and recovery time while achieving aesthetically pleasing and durable results. Methods: Recent advancements in autologous breast reconstruction have been examined, focusing on enhancements in surgical techniques, imaging technologies, minimally invasive approaches, and postoperative care. Results: To reduce donor site morbidity, attention has recently shifted back to abdominal flaps vascularized by subcutaneous vessels. Specifically, the superficial circumflex iliac artery perforator (SCIP) flap has emerged as a promising option. Additionally, robotic-assisted flap harvest serves as another method to reduce the invasiveness. At the recipient site, rib-sparing internal mammary vessel isolation and perforator-to-perforator anastomosis have been suggested to lessen trauma and maintain thoracic integrity. The use of thorough preoperative imaging and intraoperative assessment of real-time perfusion with indocyanine green angiography (ICG) has enhanced the success of the procedure. Beyond aesthetic restoration, contemporary breast reconstructive surgeons are increasingly aware of both short-term and long-term complications, particularly lymphatic sequelae. The LYMPHA technique (lymphatic microsurgical preventive healing approach) promotes immediate restoration of the lymphatic system and has shown the potential to reduce the risk of breast cancer-related lymphedema (BCRL). Furthermore, the integration of enhanced recovery after surgery (ERAS) protocols has transformed perioperative care by optimizing pain management, minimizing hospitalization duration, and allowing a quicker return to daily activities. Conclusions: Recent advancements in autologous breast reconstruction have significantly improved patient outcomes. With innovations in flap design, technology, lymphatic preservation, and recovery protocols, it has been possible to usher in a new era of less invasive procedures and fewer complications while achieving high aesthetic results and allowing patients to return to their daily lives as quickly as possible. Full article

Background: Breast cancer is the second most common cancer in women with an improving mortality rate and a growing need for reconstruction following oncologic resection. Advancements in robotic surgery and minimally invasive techniques have offered refinement to traditional open techniques of flap harvest for reconstruction, particularly regarding improved donor site morbidity. Methods: The literature review was based on a PubMed database search using the keyword “Robotic breast reconstruction” in conjunction with the Boolean operators “Flap”, “Latissimus”, and “DIEP” to specify the search. In total, 106 results were generated, which were then manually reviewed and condensed for a comprehensive stance on the current status, technique, variations, and outcomes for robotic breast reconstruction. Results: Robotic technique has been described for the latissimus dorsi (LD) and deep inferior epigastric perforator (DIEP) flaps for breast reconstruction. For LD, robotic flap harvest reduces donor site morbidity, incisional length, and hospital length of stay, with similar complication rates for seroma/hematoma/infection, and longer operative times. Robotic LD procedures have been described in conjunction with single-site nipple-sparing mastectomy and flap elevation leading to a full minimally invasive resection and reconstruction from one lateral incision. Robotic DIEP harvest offers a considerably smaller fascial incision/rectus muscle dissection and has a comparable complication rate to traditional techniques with shorter hospital length of stay, and improved pain, at the expense of longer operating times. Data on hernia/bulge reduction from robotic techniques is limited and not yet available. Conclusions: Robotic breast reconstruction offers great potential for improving breast reconstruction in terms of donor site morbidity, length of incision, hospital length of stay at the cost of longer operating times, and increased technical skill/specialization, but it has yet to be proven on a large scale with long-term outcome data. Multi-center, prospective clinical data and trials are needed to help elucidate the potential for equivalence and superiority of the minimally invasive approach compared to standard open techniques, but the future is promising for robotic surgery in breast cancer and breast reconstruction. Full article

Breast reconstruction following mastectomy or sectorectomy significantly impacts the quality of life and psychological well-being of breast cancer patients. Since its inception in the 1950s, artificial intelligence (AI) has gradually entered the medical field, promising to transform surgical planning, intraoperative guidance, postoperative care, and medical research. This article examines AI applications in breast reconstruction, supported by recent studies. AI shows promise in enhancing imaging for tumor detection and surgical planning, improving microsurgical precision, predicting complications such as flap failure, and optimizing postoperative monitoring. However, challenges remain, including data quality, safety, algorithm transparency, and clinical integration. Despite these shortcomings, AI has the potential to revolutionize breast reconstruction by improving preoperative planning, surgical precision, operative efficiency, and patient outcomes. This review provides a foundation for further research as AI continues to evolve and clinical trials expand its applications, offering greater benefits to patients and healthcare providers. Full article

Background/Objectives: Modern breast reconstruction has undergone substantial evolution, with implant-based, pedicled autologous, and free autologous techniques. The purpose of this study is to review the current state of the art in free autologous breast reconstruction, highlighting advancements in the types of flaps, donor site selection, techniques, and functional restoration. Methods: A literature review was conducted using PubMed to capture studies related to well-known free flaps that are used for breast reconstruction. Studies for each flap type were reviewed and sorted for inclusion into one of six categories: (1) clinical outcomes, (2) comparison studies of alternative flaps, (3) preoperative planning, (4) flap classifications and perfusion zones, (5) technique descriptions, and (6) time and cost analyses. Results: The majority (77%) of articles included were written on various types of abdominally based free flaps, including TRAM, DIEP, and SIEA flaps. These studies indicated an evolution in technique over time to minimize donor site morbidity, improve patient-reported and functional outcomes, improve efficiency, and expand clinical indications. The remaining 23% of articles discussed alternative flap choices, including PAP, TUG, S/IGAP, and LAP flaps. Studies highlighted technical challenges and the evolution of techniques to make these flaps more accessible, as well as how to combine flaps to expand clinical indications. Conclusions: Autologous breast reconstruction has evolved significantly, with advancements in techniques such as robotic-assisted surgery, multi-flap reconstruction, bipedicled flaps, and neurotization. This review highlights the current best practices while acknowledging ongoing challenges and the potential for future innovations in microsurgery, nerve regeneration, and personalized medicine, which hold promise for further refining outcomes. Full article

Background/Objectives: Robotic systems offer enhanced precision, dexterity, and visualization, which are essential in addressing the complex nature of plastic surgery procedures. Despite widespread adoption in other surgical specialties, such as urology and gynecology, their application in plastic surgery remains underexplored. This review examines the use of robotic systems in plastic and reconstructive surgery with a focus on clinical outcomes. Methods: A literature search was conducted using PubMed, Embase, Scopus, and Web of Science. Search terms included (“robotic surgery” OR “surgical robots”) AND (“plastic surgery” OR “reconstructive surgery”). Studies on clinical outcomes and biomimetic innovations published between 1980 and 2024 were included, while non-English, cadaver-based, and animal studies were excluded. Data were systematically extracted using Covidence and analyzed. Results: Twenty-nine studies were identified that evaluated the clinical outcomes of robotics in areas including breast reconstruction, microsurgery, and craniofacial procedures. Robotic systems like the Da Vinci and Symani platforms offer motion scaling, tremor elimination, and enhanced depth perception. In nipple-sparing mastectomies, they reduced skin necrosis rates from 8% to 2%, while in DIEP flap reconstruction, they enabled smaller fascial incisions (2.67 ± 1.13 cm vs. 8.14 ± 1.69 cm) and faster recovery with fewer complications. In microsurgery, they achieved 100% patency for vessels under 0.3 mm and a 25.2% limb volume reduction in lymphedema patients in 3 months. Conclusions: Robotic systems show significant promise, particularly in procedures such as nipple-sparing mastectomies, and have the potential to overcome challenges including surgeon fatigue. However, challenges such as longer operating times, high costs, and limited haptic feedback remain barriers to their adoption. Full article

Background/Objectives: Robotic breast reconstruction is an innovative surgical technique that integrates robotic technology into breast reconstruction procedures, offering several advantages over conventional approaches. These benefits include enhanced visualization, increased surgical dexterity, and superior cosmetic outcomes. This study aims to comprehensively compare robotic-assisted and conventional breast reconstruction approaches in terms of complication profiles and operation-related measurements. Methods: A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, Google Scholar, CENTRAL, and VHL from inception to October 2024 to identify relevant studies. Risk ratios for the following complications were calculated between the groups: donor site seroma, hematoma, infection, and unplanned reoperation. Mean differences were also calculated for the duration of surgery, length of postoperative hospital stays, and opioid use. Results: A meta-analysis was performed on 9 studies including a total of 1094 patients. No significant differences were found between the groups in the risk ratios for reoperation, seroma formation, delayed healing, infections, and hematomas. Similarly, there were no significant differences in postoperative opioid use. The duration of surgery was longer in the robot-assisted reconstruction group, whereas the duration of hospital stay was shorter compared to the conventional group. Meta-regression analysis for the duration of surgery model showed that none of the moderators had a statistically significant effect on this outcome. ROBINS-I assessment indicated that all the included studies had a serious risk of bias. Conclusions: Our results suggest that using a robot-assisted approach is associated with a shorter duration of hospital stay and a longer duration of surgery. Full article

Minimally invasive interventional surgery is commonly used for diagnosing and treating breast cancer, but the high fluidity and deformability of breast tissue reduce intervention accuracy. This study proposes a bionic breast interventional robot that mimics the scorpion’s predation process, actively manipulating tissue deformation to control target displacement and enhance accuracy. The robot’s structure is designed using a modular method, and its kinematics and workspace are analyzed and solved. To address the nonlinear breast tissue deformation problem, a hierarchical tissue method is proposed to simplify the three-dimensional problem into a two-dimensional one. A two-dimensional tissue deformation solver is established based on the minimum energy method for quick resolution. The problem is treated as quasi-static, deriving the displacement relationship between external manipulation points and internal tissue targets. The method of active manipulation of tissue deformation is simulated using MATLAB (2019-b) software to verify the feasibility of the method. Results show maximum errors of 1.7 mm for prostheses and 2.5 mm for in vitro tissues in the X and Y directions. This method improves intervention accuracy in breast surgery and offers a new solution for breast cancer diagnosis and treatment. Full article