ROBOTIC-ASSISTED NIPPLE-SPARING MASTECTOMY WITH THE DA VINCI SURGICAL SYSTEM COMPARED TO OPEN SURGERY: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS
Author(s)
Neera Patel1, Usha Kreaden, MSc2, Ana Yankovsky, MSc3;
1Intuitive Surgical, Research Analyst Global Evidence Mgmt, Yorba Linda, CA, USA, 2Intuitive Surgical, Sunnyvale, CA, USA, 3Intuitive Surgical, Palo Alto, CA, USA
1Intuitive Surgical, Research Analyst Global Evidence Mgmt, Yorba Linda, CA, USA, 2Intuitive Surgical, Sunnyvale, CA, USA, 3Intuitive Surgical, Palo Alto, CA, USA
OBJECTIVES: To evaluate the clinical and patient outcomes after robotic-assisted surgery (RAS) compared to open surgery for nipple-sparing mastectomy (NSM).
METHODS: A systematic search for studies published between 2010 and January 15, 2025 and comparing RAS and open NSM for prophylactic and cancer indications was conducted. Publications were excluded if not in English, pediatric cases, mixed procedures or study arms, absence of relevant outcomes, or redundant data. A meta-analysis was conducted using R packages with a random model applied when significant heterogeneity was present.
RESULTS: We identified 10 relevant studies: 1 randomized controlled trial, 2 prospective cohort studies, and 7 retrospective cohort studies. Compared to open surgery, RAS patients had fewer 30-day postoperative complications (OR: 0.66 [0.51, 0.85], p<0.01), fewer 30-day reoperations (OR: 0.58 [0.34, 0.99], p=0.049), less nipple areolar complex (NAC) necrosis (OR: 0.43 [0.23, 0.79], p<0.01), and shorter incision length (MD: -4.45 [-4.86, -4.04], p<0.01). Open surgery patients had shorter operative times (without reconstruction MD: 75.32 [36.22, 114.43], p<0.01; with reconstruction MD: 61.32 [26.33, 96.31], p<0.01) and shorter length of stay (MD: 0.91 [0.25, 1.57], p<0.01). Both groups had similar estimated blood loss, 30-day mortality, nipple necrosis, skin necrosis, infection, and positive surgical margins. No conversions to open surgery were reported among the RAS patients. There were no data available on blood transfusions, 30-day readmissions, lymph node yield, number of incisions, duration of drainage, and quality of life scores.
CONCLUSIONS: Our results demonstrate that using da Vinci RAS compared to the open approach for NSM results in some added benefits to the patient, including reductions in postoperative complications, reoperations, NAC necrosis, and incision length. These findings can aid decisionmakers and HTA bodies with evaluating RAS for breast surgery. More research is needed on patient quality of life and functional outcomes.
METHODS: A systematic search for studies published between 2010 and January 15, 2025 and comparing RAS and open NSM for prophylactic and cancer indications was conducted. Publications were excluded if not in English, pediatric cases, mixed procedures or study arms, absence of relevant outcomes, or redundant data. A meta-analysis was conducted using R packages with a random model applied when significant heterogeneity was present.
RESULTS: We identified 10 relevant studies: 1 randomized controlled trial, 2 prospective cohort studies, and 7 retrospective cohort studies. Compared to open surgery, RAS patients had fewer 30-day postoperative complications (OR: 0.66 [0.51, 0.85], p<0.01), fewer 30-day reoperations (OR: 0.58 [0.34, 0.99], p=0.049), less nipple areolar complex (NAC) necrosis (OR: 0.43 [0.23, 0.79], p<0.01), and shorter incision length (MD: -4.45 [-4.86, -4.04], p<0.01). Open surgery patients had shorter operative times (without reconstruction MD: 75.32 [36.22, 114.43], p<0.01; with reconstruction MD: 61.32 [26.33, 96.31], p<0.01) and shorter length of stay (MD: 0.91 [0.25, 1.57], p<0.01). Both groups had similar estimated blood loss, 30-day mortality, nipple necrosis, skin necrosis, infection, and positive surgical margins. No conversions to open surgery were reported among the RAS patients. There were no data available on blood transfusions, 30-day readmissions, lymph node yield, number of incisions, duration of drainage, and quality of life scores.
CONCLUSIONS: Our results demonstrate that using da Vinci RAS compared to the open approach for NSM results in some added benefits to the patient, including reductions in postoperative complications, reoperations, NAC necrosis, and incision length. These findings can aid decisionmakers and HTA bodies with evaluating RAS for breast surgery. More research is needed on patient quality of life and functional outcomes.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
MT19
Topic
Medical Technologies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, STA: Surgery