Breast cancer is increasing in incidence world over with 1 in 9 being affected in many countries. Both breast and thyroid tumors are common in women where cosmesis is desired with cure at the same time.
Robotic nipple-sparing mastectomy (RNSM) has emerged as a new treatment option for breast cancer and risk-reducing mastectomy (RRM) for women who have a high risk of pathogenic variants of Breast cancer Genes,BRCA1 and BRCA2.
da Vinci Xi in Apollo offers the precise “Endo-wrist” feature, which replicates the hands of skilled surgeons with greater degree of freedom compared to conventional laparoscopic or endoscopic devices in a small operative fields breast tumors with remote incisions away from the visible from the Breast, chest area in breast cases. The three dimensional magnification view in the camera provides a better view of the operative fields for surgeons to allow more delicate and meticulous tissue handling, suture, and dissection. The smaller robotic arm, compared to previous robotic systems, can minimize tissue injury, resulting in reduced surgical infections.
Apollo has been in the forefront of providing the advanced facilities in surgical approaches for these cases.
Proper selection of case is very important and there is a need of extensively experienced robotic team. Dr.Jagdishwar Goud Gajagowni team at Apollo is the first team to start robotic cancer surgery in Telugu states and have till now crossed 5,000 robotic cancer surgeries. He is also a mentor for robotic surgery and trained surgeons in many institutions like Adyar, AIIMS,TATA medical center, SGPGI ,MNJ,NIMS and many Private hospitals.
Our team has designed an innovative approach for select cases of breast cancer with due consent, an UNIPORTAL-ROBOTIC ASSITED BREATS SURGERY- U-RABS
We use a small incision of 3cms in armpit and access the breast area with DaVinci Xi arms and dissect the breast area and axillary nodes with sparing of nipple and areola. During the procedure we do SLN-Sentinel Lymph Node biopsy and do dissection only for positive nodal cases, also tissue under nipple and aerola is sent for intraoperative biopsy called Frozen Section and spare them only if no tumor is found underneath. Patient undergoes immediate breast reconstruction with gel implant +/- Latissmus dorsi flap.
Indications for EABS or RABS include early-stage breast cancer (ductal carcinoma in situ, stage I, II or IIIA), a tumor size less than 3 cm (for BCS) or no larger than 5 cm (for mastectomy), absence of apparent multiple lymph nodes metastases, and absence of skin or chest wall invasion.
Patients for whom EABS or RABS was contraindicated include those with inflammatory breast cancer, breast cancer with chest wall or skin invasion, locally advanced breast cancer, breast cancer with extensive axillary lymph node metastasis (stage IIIB or later), and severe comorbidities, such as heart disease, renal failure, liver dysfunction, and poor performance status as assessed by their primary physicians.
Whether breast reconstructions were performed immediately or at a later time is decided with patients and physicians’ shared decision making.
Breast reconstructions after minimal access mastectomy (or aesthetic scar-less mastectomy) can be performed by using an implant (cohesive gel implants or tissue expander or autologous tissue with latissimus dorsi (LD) flap or abdominal flap
Current optimal scar incision location is in the anterior axillary line at the level of NAC. This location enables sentinel lymph node biopsy and NSM with IGBR. An asset of this location is that this scar could be well hidden along the bra-line
The highlight of MABS lies in its small inconspicuous operation scar and high patient satisfaction. The previously criticized extensive operation time had decreased steadily due to technique refinements and the surgical team’s procedural familiarity.