Early Postoperative Outcomes of Tumescent-Free Single-Port Robot-Assisted Nipple-Sparing Mastectomy Compared with Tumescent-Using Technique: A Substudy of Retrospective Multicenter Study (SPROUT, KoREa-BSG 14)

Abstract

Background: Robot-assisted nipple-sparing mastectomy (RANSM) has transformed breast cancer surgery by offering precise dissection, reduced scarring, and quicker recovery. Single-port RANSM (SP-RANSM) builds on these advancements, with debates surrounding the use of tumescent dissection technique owing to potential complications and increased operative time. This study compares the early postoperative outcomes of the two techniques to guide surgical decision-making and improve patient care.

Patients and Methods: We analyzed data from patients who underwent SP-RANSM between January 2018 and November 2023 across 12 South Korean institutions. The analysis focused on operative times, surgical details, and adverse events, comparing the tumescent-free and tumescent techniques.

Results: The cohort included 280 patients who underwent tumescent-free SP-RANSM and 150 who underwent tumescent SP-RANSM. The tumescent group had a greater prevalence of comorbidities, fewer multifocal but more multicentric lesions, and more tissue expander reconstruction. A total of 179 patients, representing 39.8%, were clinically staged at stage II or above. The tumescent-free group had longer predocking times but shorter console times and less intraoperative bleeding. Total operative times were similar between the two techniques. Adverse events occurred in 16.8% of tumescent-free and 23.3% of tumescent patients, with no significant difference in the distribution of adverse event types between groups. The most common adverse events were seroma and bleeding/hematoma.

Conclusions: Both tumescent-free and tumescent SP-RANSM can be safely implemented with appropriate patient selection and surgical expertise. Future research should focus on long-term outcomes, cost-effectiveness, and patient-reported outcomes to further guide clinical practice in robotic breast surgery.