Cutting-edge trends in da Vinci single-port robotic approaches to breast surgery: a narrative review

초록

The da Vinci single-port (SP) platform (Intuitive Surgical, Inc.) has catalyzed a new phase of remote-access breast surgery by delivering multi-jointed, wristed instrumentation and stable 3-dimensional optics through a single trocar. This narrative review synthesizes contemporary evidence and practice patterns for SP-assisted procedures, drawing on a recent series of robotic nipple-sparing mastectomies (NSMs). Indications parallel conventional NSM with patient selection favoring small-to-moderate breasts and tumors distant from the nipple-areolar complex; formal contraindications largely mirror those of open techniques. SP kinematic features, such as cobra wrist configurations, diminish the blind spots typical of multiport approaches, and the SP system's combined multi-image display supports real-time imaging overlays that help maintain uniform flap thickness. Across comparative cohorts, overall postoperative complication rates with robotic approaches do not differ significantly from conventional NSM. Oncologic follow-up remains limited, underscoring the need for longer surveillance to establish non-inferiority. Cosmesis and patient satisfaction are consistently superior due to hidden incisions and improved contour. Unique risks demand caution, notably skin-flap ischemia/necrosis, as well as the opposite risk of residual tissue when flaps are made too thick. Safe adoption depends on structured training that includes device familiarization, team-based drills, high-fidelity simulation, and staged proctoring. Recognition of a learning curve characterized by substantial reductions in operative time was found across initial cases. Critical priorities are prospective, controlled trials of oncologic outcomes, standardized frameworks for credentialing and competency, and comprehensive cost-effectiveness evaluations. With disciplined case selection, standardized flap assessment, and team-based training, SP robotic breast surgery achieves concealed-scar cosmesis while maintaining core oncologic principles.

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