Oncological safety in endoscopic and robotic breast-conserving surgery and breast reconstruction surgery for breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Yihang ¹ , CAO Xiaoman ^2,3 , LI Tianyuan ^2,3 , DAI Hui ^2,3 , ZHANG Qing ^2,3 , CHUNG Kawu ^2,3 ,  DU Zhenggui ^2,3

1. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
2. Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Breast Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

DU Zhenggui, Email: docduzg@163.com

Keywords：

breast cancer; endoscopic surgery; robotic surgery; oncological safety

DOI：

10.7507/1007-9424.202502085

Video：

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Endoscopic and robotic surgeries feature small incision and reducing surgical trauma, and minimized incision scars. However, the oncological safety of their application in breast-conserving surgery and breast reconstruction for breast cancer has always been a focal clinical concern. The breast-conserving surgery and breast reconstruction using the suspension, insufflation, and lipolysis methods could achieve precise tumor resection in the selected patients and under the specific surgical conditions, with the support of appropriate instruments. Meanwhile, the innovative application of the reverse-sequence method and auxiliary port technique has further enhanced surgical efficiency and the precision of tumor resection. Current studies suggest that endoscopic and robotic-assited breast-conserving surgery and breast reconstruction yield in terms of oncological outcomes comparable to those of conventional open breast-conserving surgery, including positive margins, local recurrence, regional recurrence, distant metastasis, and overall survival. These approaches offered advantages in minimally invasive techniques and aesthetic outcomes. However, existing research was limited by short follow-up period and small sample sizes. Future large-scale, long-term prospective randomized controlled trials are needed to further validate their oncological safety and long-term efficacy. These studies could help establish novel techniques as standard surgical approaches for breast cancer, particularly the efficient and streamlined reverse-sequence endoscopic and auxiliary port-assisted techniques.

Citation： ZHANG Yihang, CAO Xiaoman, LI Tianyuan, DAI Hui, ZHANG Qing, CHUNG Kawu, DU Zhenggui. Oncological safety in endoscopic and robotic breast-conserving surgery and breast reconstruction surgery for breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(3): 265-271. doi: 10.7507/1007-9424.202502085 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	姜军, 杨新华, 范林军, 等. 腔镜手术在乳腺疾病外科治疗中的应用. 中华医学杂志, 2005, 85(3): 181-183.
3.	屈翔, 王子函, 王劲夫, 等. 腔镜手术在乳腺癌外科的应用与前景. 中国实用外科杂志, 2018, 38(11): 1245-1248.
4.	Kerbl DC, McDougall EM, Clayman RV, et al. A history and evolution of laparoscopic nephrectomy: perspectives from the past and future directions in the surgical management of renal tumors. J Urol, 2011, 185(3): 1150-1154.
5.	吴淞, 章佳新. 乳腺腔镜手术操作空间建立的进展分析. 中国继续医学教育, 2020, 12(12): 114-116.
6.	刘顺顺, 李平, 李忠, 等. 腔镜腋窝淋巴结清扫在早期乳腺癌保乳手术中的应用. 中国普通外科杂志, 2012, 21(5): 516-520.
7.	谢妍妍, 吕青, 杜正贵. 乳腺腔镜和机器人手术的现状及未来之路—华西医院经验分享. 外科理论与实践, 2022, 27(5): 396-402.
8.	Yamashita K, Shimizu K. Endoscopic video-assisted breast surgery: procedures and short-term results. J Nippon Med Sch, 2006, 73(4): 193-202.
9.	Yamashita K, Shimizu K. Trans-axillary retro-mammary gland route approach of video-assisted breast surgery can perform breast conserving surgery for cancers even in inner side of the breast. Chin Med J (Engl), 2008, 121(20): 1960-1964.
10.	Nakajima H, Fujiwara I, Mizuta N, et al. Video-assisted skin-sparing breast-conserving surgery for breast cancer and immediate reconstruction with autologous tissue. Ann Surg, 2009, 249(1): 91-96.
11.	Nakajima H, Fujiwara I, Mizuta N, et al. Video-assisted skin-sparing breast-conserving surgery for breast cancer and immediate reconstruction with autologous tissue: clinical outcomes. Ann Surg Oncol, 2009, 16(7): 1982-1989.
12.	Nakajima H, Fujiwara I, Mizuta N, et al. Clinical outcomes of video-assisted skin-sparing partial mastectomy for breast cancer and immediate reconstruction with latissimus dorsi muscle flap as breast-conserving therapy. World J Surg, 2010, 34(9): 2197-2203.
13.	Park HS, Lee JS, Lee JS, et al. The feasibility of endoscopy-assisted breast conservation surgery for patients with early breast cancer. J Breast Cancer, 2011, 14(1): 52-57.
14.	Saimura M, Mitsuyama S, Anan K, et al. Endoscopy-assisted breast-conserving surgery for early breast cancer. Asian J Endosc Surg, 2013, 6(3): 203-208.
15.	Ozaki S, Ohara M. Endoscopy-assisted breast-conserving surgery for breast cancer patients. Gland Surg, 2014, 3(2): 94-108.
16.	Takahashi H, Fujii T, Nakagawa S, et al. Usefulness of endoscopic breast-conserving surgery for breast cancer. Surg Today, 2014, 44(11): 2037-2044.
17.	Lai HW, Mok CW, Chang YT, et al. Endoscopic assisted breast conserving surgery for breast cancer: Clinical outcome, learning curve, and patient reported aesthetic results from preliminary 100 procedures. Eur J Surg Oncol, 2020, 46(8): 1446-1455.
18.	Lai HW, Chen ST, Lin YJ, et al. Minimal access (endoscopic and robotic) breast surgery in the surgical treatment of early breast cancer-trend and clinical outcome from a single-surgeon experience over 10 years. Front Oncol, 2021, 11: 739144. doi: 10.3389/fonc.2021.739144.
19.	徐威, 王子函, 高国璇, 等. 单孔充气法腔镜乳腺癌保乳手术66例疗效分析. 中国实用外科杂志, 2020, 40(10): 1155-1158.
20.	Xie F, Wang ZH, Wu SS, et al. Comparing outcomes of single-port insufflation endoscopic breast-conserving surgery and conventional open approach for breast cancer. World J Surg Oncol, 2022, 20(1): 335. doi: 10.1186/s12957-022-02798-6.
21.	邱梦雪, 杨焕佐, 周娇, 等. 基于华西三号孔的腋窝入路腔镜乳腺良性肿瘤切除及恶性肿瘤保乳术技巧与疗效分析. 中国胸心血管外科临床杂志, 2023, 30(3): 350-356.
22.	Yu HY, Friedlander DF, Patel S, et al. The current status of robotic oncologic surgery. CA Cancer J Clin, 2013, 63(1): 45-56.
23.	Morrow M. Robotic nipple-sparing mastectomy-ready for prime time?. JAMA Surg, 2024, 159(3): 276. doi: 10.1001/jamasurg.2023.7007.
24.	中国抗癌协会乳腺癌专业委员会, 中国医师协会外科医师分会乳腺外科医师委员会, 上海市抗癌协会乳腺癌专业委员会. 乳腺肿瘤整形与乳房重建专家共识(2022年版). 中国癌症杂志, 2022, 32(9): 836-924.
25.	Franceschini G, Visconti G, Garganese G, et al. Nipple-sparing mastectomy combined with endoscopic immediate reconstruction via axillary incision for breast cancer: A preliminary experience of an innovative technique. Breast J, 2020, 26(2): 206-210.
26.	关山, 王宇, 张开通, 等. 应用皮肤悬吊系统腔镜下保留乳头乳晕乳腺切除即刻乳房重建. 中华外科杂志, 2017, 55(2): 126-129.
27.	Langer I, Kocher T, Guller U, et al. Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients. Breast Cancer Res Treat, 2005, 90(1): 85-91.
28.	Salvat J, Knopf JF, Ayoubi JM, et al. Endoscopic exploration and lymph node sampling of the axilla. Preliminary findings of a randomized pilot study comparing clinical and anatomo-pathologic results of endoscopic axillary lymph node sampling with traditional surgical treatment. Eur J Obstet Gynecol Reprod Biol, 1996, 70(2): 165-173.
29.	Malur S, Bechler J, Schneider A. Endoscopic axillary lymphadenectomy without prior liposuction in 100 patients with invasive breast cancer. Surg Laparosc Endosc Percutan Tech, 2001, 11(1): 38-42.
30.	Wan A, Liang Y, Chen L, et al. Association of long-term oncologic prognosis with minimal access breast surgery vs conventional breast surgery. JAMA Surg, 2022, 157(12): e224711. doi: 10.1001/jamasurg.2022.4711.
31.	高国璇, 王红卫, 丁国乾, 等. 单孔充气法腔镜胸肌前一期假体植入乳房重建术临床分析. 国际外科学杂志, 2022, 49(3): 168-174, C2.
32.	Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-sparing mastectomy: Technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.
33.	Lee HY, Chang YW, Yu DY, et al. Comparison of single incision endoscopic nipple-sparing mastectomy and conventional nipple-sparing mastectomy for breast cancer based on initial experience. J Breast Cancer, 2021, 24(2): 196-205.
34.	Luo C, Guo W, Yang J, et al. Comparison of mastoscopic and conventional axillary lymph node dissection in breast cancer: long-term results from a randomized, multicenter trial. Mayo Clin Proc, 2012, 87(12): 1153-1161.
35.	郭美琴. 吸脂法腔镜腋窝淋巴结清扫术淋巴结组织学改变的临床对照研究. 2007中国外科周暨第16届亚洲外科年会论文集, 2007: 127-128.
36.	Donnely E, Griffin MF, Butler PE. Robotic surgery: A novel approach for breast surgery and reconstruction. Plast Reconstr Surg Glob Open, 2020, 8(1): e2578. doi: 10.1097/GOX.0000000000002578.
37.	Sarfati B, Toesca A, Roulot A, et al. Transumbilical single-port robotically assisted nipple-sparing mastectomy: A cadaveric study. Plast Reconstr Surg Glob Open, 2020, 8(5): e2778. doi: 10.1097/GOX.0000000000002778.
38.	Toesca A, Invento A, Massari G, et al. Update on the feasibility and progress on robotic breast surgery. Ann Surg Oncol, 2019, 26(10): 3046-3051.
39.	Lai HW, Chen ST, Mok CW, et al. Robotic versus conventional nipple sparing mastectomy and immediate gel implant breast reconstruction in the management of breast cancer—A case control comparison study with analysis of clinical outcome, medical cost, and patient-reported cosmetic results. J Plast Reconstr Aesthet Surg, 2020, 73(8): 1514-1525.
40.	Huang JJ, Chuang EY, Cheong DC, et al. Robotic-assisted nipple-sparing mastectomy followed by immediate microsurgical free flap reconstruction: Feasibility and aesthetic results—Case series. Int J Surg, 2021, 95: 106143. doi: 10.1016/j.ijsu.2021.106143.
41.	Park HS, Lee J, Lai HW, et al. Surgical and oncologic outcomes of robotic and conventional nipple-sparing mastectomy with immediate reconstruction: International multicenter pooled data analysis. Ann Surg Oncol, 2022, 29(11): 6646-6657.
42.	Toesca A, Sangalli C, Maisonneuve P, et al. A randomized trial of robotic mastectomy versus open surgery in women with breast cancer or BrCA mutation. Ann Surg, 2022, 276(1): 11-19.
43.	Lai HW, Chen DR, Liu LC, et al. Robotic versus conventional or endoscopic-assisted nipple-sparing mastectomy and immediate prosthesis breast reconstruction in the management of breast cancer: A prospectively designed multicenter trial comparing clinical outcomes, medical cost, and patient-reported outcomes (RCENSM-P). Ann Surg, 2024, 279(1): 138-146.
44.	Lin YC, Lui SA, Chen MY, et al. Safety and feasibility of robotic nipple-sparing mastectomy with immediate direct-to-implant reconstruction—Insights from the one of the largest centers in Asia. Clin Breast Cancer, 2024 Dec 25: S1526-S8209(24)00364-1. doi: 10.1016/j.clbc.2024.12.013.
45.	Lee SB, Kim J, Chung IY, et al. Use of the Da Vinci SP surgical system in robot-assisted nipple-sparing mastectomy: a single-center, retrospective study. Sci Rep, 2025, 15(1): 12. doi: 10.1038/s41598-024-84807-0.
46.	Zhang S, Xie Y, Liang F, et al. Video-assisted transaxillary nipple-sparing mastectomy and immediate implant-based breast reconstruction: A novel and promising method. Aesthetic Plast Surg, 2022, 46(1): 91-98.
47.	周娇, 梁法清, 谢妍妍, 等. 华西医院日间腔镜乳腺皮下切除联合一期假体重建的临床路径简介. 中国胸心血管外科临床杂志, 2021, 28(12): 1393-1399.
48.	覃湘泉, 王甜甜, 谢妍妍, 等. 腋窝入路腔镜下乳腺癌皮下腺体切除联合胸肌前假体+补片Ⅰ期乳房重建的创新探索. 中国胸心血管外科临床杂志, 2021, 28(9): 1029-1036.
49.	海琳悦, 王雪菲, 刘博文, 等. 经腋窝单孔充气法乳腺腔镜手术治疗乳腺疾病的临床应用分析. 中国肿瘤临床, 2023, 50(5): 255-259.
50.	刘岩青, 崔磊, 方晓明, 等. 经腋窝单孔非溶脂全腔镜乳房皮下腺体切除联合假体乳房重建术的临床分析. 中华内分泌外科杂志, 2024, 18(2): 190-195.
51.	Chung K, Xie Y, Liang F, et al. Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery. Front Oncol, 2024, 14: 1366877. doi: 10.3389/fonc.2024.1366877.
52.	Dai H, Chung K, Liang F, et al. Safety and aesthetic outcomes of double purse-string suture nipple reconstruction in early breast cancer patients undergoing nipple resection and endoscopic skin-sparing mastectomy with breast reconstruction. Front Oncol, 2024, 14: 1462850. doi: 10.3389/fonc.2024.1462850.
53.	Qiu M, Liang F, Xie Y, et al. Clinical outcomes of transaxillary reverse-sequence endoscopic nipple-sparing mastectomy and direct-to-implant prepectoral breast reconstruction: A prospective study of initial 68 procedures. Ann Surg Oncol, 2024, 31(4): 2777-2785.
54.	Zhou J, Xie Y, Liang F, et al. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
55.	陈阔, 吕鹏威. 达芬奇机器人保留乳头乳晕乳腺切除即刻假体乳房重建术中预防热蒸汽损伤皮肤组织临床研究. 中国修复重建外科杂志, 2024, 38(7): 813-817.
56.	Ramakrishnan VV, Southern S, Villafane O. Endoscopically assisted latissimus dorsi harvest and prosthetic placement. Br J Plast Surg, 1997, 50(3): 219-220.
57.	Qiu J, Wen N, Xie Y, et al. Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery. Gland Surg, 2022, 11(8): 1383-1394.
58.	Feng Y, Wen N, Liang F, et al. Endoscopic nipple- or skin-sparing mastectomy and immediate breast reconstruction with endoscopic harvesting of the latissimus dorsi flap: a preliminary experience of an innovative technique. Breast J, 2022, 2022: 1373899. doi: 10.1155/2022/1373899.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 姜军, 杨新华, 范林军, 等. 腔镜手术在乳腺疾病外科治疗中的应用. 中华医学杂志, 2005, 85(3): 181-183.
3. 屈翔, 王子函, 王劲夫, 等. 腔镜手术在乳腺癌外科的应用与前景. 中国实用外科杂志, 2018, 38(11): 1245-1248.
4. Kerbl DC, McDougall EM, Clayman RV, et al. A history and evolution of laparoscopic nephrectomy: perspectives from the past and future directions in the surgical management of renal tumors. J Urol, 2011, 185(3): 1150-1154.
5. 吴淞, 章佳新. 乳腺腔镜手术操作空间建立的进展分析. 中国继续医学教育, 2020, 12(12): 114-116.
6. 刘顺顺, 李平, 李忠, 等. 腔镜腋窝淋巴结清扫在早期乳腺癌保乳手术中的应用. 中国普通外科杂志, 2012, 21(5): 516-520.
7. 谢妍妍, 吕青, 杜正贵. 乳腺腔镜和机器人手术的现状及未来之路—华西医院经验分享. 外科理论与实践, 2022, 27(5): 396-402.
8. Yamashita K, Shimizu K. Endoscopic video-assisted breast surgery: procedures and short-term results. J Nippon Med Sch, 2006, 73(4): 193-202.
9. Yamashita K, Shimizu K. Trans-axillary retro-mammary gland route approach of video-assisted breast surgery can perform breast conserving surgery for cancers even in inner side of the breast. Chin Med J (Engl), 2008, 121(20): 1960-1964.
10. Nakajima H, Fujiwara I, Mizuta N, et al. Video-assisted skin-sparing breast-conserving surgery for breast cancer and immediate reconstruction with autologous tissue. Ann Surg, 2009, 249(1): 91-96.
11. Nakajima H, Fujiwara I, Mizuta N, et al. Video-assisted skin-sparing breast-conserving surgery for breast cancer and immediate reconstruction with autologous tissue: clinical outcomes. Ann Surg Oncol, 2009, 16(7): 1982-1989.
12. Nakajima H, Fujiwara I, Mizuta N, et al. Clinical outcomes of video-assisted skin-sparing partial mastectomy for breast cancer and immediate reconstruction with latissimus dorsi muscle flap as breast-conserving therapy. World J Surg, 2010, 34(9): 2197-2203.
13. Park HS, Lee JS, Lee JS, et al. The feasibility of endoscopy-assisted breast conservation surgery for patients with early breast cancer. J Breast Cancer, 2011, 14(1): 52-57.
14. Saimura M, Mitsuyama S, Anan K, et al. Endoscopy-assisted breast-conserving surgery for early breast cancer. Asian J Endosc Surg, 2013, 6(3): 203-208.
15. Ozaki S, Ohara M. Endoscopy-assisted breast-conserving surgery for breast cancer patients. Gland Surg, 2014, 3(2): 94-108.
16. Takahashi H, Fujii T, Nakagawa S, et al. Usefulness of endoscopic breast-conserving surgery for breast cancer. Surg Today, 2014, 44(11): 2037-2044.
17. Lai HW, Mok CW, Chang YT, et al. Endoscopic assisted breast conserving surgery for breast cancer: Clinical outcome, learning curve, and patient reported aesthetic results from preliminary 100 procedures. Eur J Surg Oncol, 2020, 46(8): 1446-1455.
18. Lai HW, Chen ST, Lin YJ, et al. Minimal access (endoscopic and robotic) breast surgery in the surgical treatment of early breast cancer-trend and clinical outcome from a single-surgeon experience over 10 years. Front Oncol, 2021, 11: 739144. doi: 10.3389/fonc.2021.739144.
19. 徐威, 王子函, 高国璇, 等. 单孔充气法腔镜乳腺癌保乳手术66例疗效分析. 中国实用外科杂志, 2020, 40(10): 1155-1158.
20. Xie F, Wang ZH, Wu SS, et al. Comparing outcomes of single-port insufflation endoscopic breast-conserving surgery and conventional open approach for breast cancer. World J Surg Oncol, 2022, 20(1): 335. doi: 10.1186/s12957-022-02798-6.
21. 邱梦雪, 杨焕佐, 周娇, 等. 基于华西三号孔的腋窝入路腔镜乳腺良性肿瘤切除及恶性肿瘤保乳术技巧与疗效分析. 中国胸心血管外科临床杂志, 2023, 30(3): 350-356.
22. Yu HY, Friedlander DF, Patel S, et al. The current status of robotic oncologic surgery. CA Cancer J Clin, 2013, 63(1): 45-56.
23. Morrow M. Robotic nipple-sparing mastectomy-ready for prime time?. JAMA Surg, 2024, 159(3): 276. doi: 10.1001/jamasurg.2023.7007.
24. 中国抗癌协会乳腺癌专业委员会, 中国医师协会外科医师分会乳腺外科医师委员会, 上海市抗癌协会乳腺癌专业委员会. 乳腺肿瘤整形与乳房重建专家共识(2022年版). 中国癌症杂志, 2022, 32(9): 836-924.
25. Franceschini G, Visconti G, Garganese G, et al. Nipple-sparing mastectomy combined with endoscopic immediate reconstruction via axillary incision for breast cancer: A preliminary experience of an innovative technique. Breast J, 2020, 26(2): 206-210.
26. 关山, 王宇, 张开通, 等. 应用皮肤悬吊系统腔镜下保留乳头乳晕乳腺切除即刻乳房重建. 中华外科杂志, 2017, 55(2): 126-129.
27. Langer I, Kocher T, Guller U, et al. Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients. Breast Cancer Res Treat, 2005, 90(1): 85-91.
28. Salvat J, Knopf JF, Ayoubi JM, et al. Endoscopic exploration and lymph node sampling of the axilla. Preliminary findings of a randomized pilot study comparing clinical and anatomo-pathologic results of endoscopic axillary lymph node sampling with traditional surgical treatment. Eur J Obstet Gynecol Reprod Biol, 1996, 70(2): 165-173.
29. Malur S, Bechler J, Schneider A. Endoscopic axillary lymphadenectomy without prior liposuction in 100 patients with invasive breast cancer. Surg Laparosc Endosc Percutan Tech, 2001, 11(1): 38-42.
30. Wan A, Liang Y, Chen L, et al. Association of long-term oncologic prognosis with minimal access breast surgery vs conventional breast surgery. JAMA Surg, 2022, 157(12): e224711. doi: 10.1001/jamasurg.2022.4711.
31. 高国璇, 王红卫, 丁国乾, 等. 单孔充气法腔镜胸肌前一期假体植入乳房重建术临床分析. 国际外科学杂志, 2022, 49(3): 168-174, C2.
32. Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-sparing mastectomy: Technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.
33. Lee HY, Chang YW, Yu DY, et al. Comparison of single incision endoscopic nipple-sparing mastectomy and conventional nipple-sparing mastectomy for breast cancer based on initial experience. J Breast Cancer, 2021, 24(2): 196-205.
34. Luo C, Guo W, Yang J, et al. Comparison of mastoscopic and conventional axillary lymph node dissection in breast cancer: long-term results from a randomized, multicenter trial. Mayo Clin Proc, 2012, 87(12): 1153-1161.
35. 郭美琴. 吸脂法腔镜腋窝淋巴结清扫术淋巴结组织学改变的临床对照研究. 2007中国外科周暨第16届亚洲外科年会论文集, 2007: 127-128.
36. Donnely E, Griffin MF, Butler PE. Robotic surgery: A novel approach for breast surgery and reconstruction. Plast Reconstr Surg Glob Open, 2020, 8(1): e2578. doi: 10.1097/GOX.0000000000002578.
37. Sarfati B, Toesca A, Roulot A, et al. Transumbilical single-port robotically assisted nipple-sparing mastectomy: A cadaveric study. Plast Reconstr Surg Glob Open, 2020, 8(5): e2778. doi: 10.1097/GOX.0000000000002778.
38. Toesca A, Invento A, Massari G, et al. Update on the feasibility and progress on robotic breast surgery. Ann Surg Oncol, 2019, 26(10): 3046-3051.
39. Lai HW, Chen ST, Mok CW, et al. Robotic versus conventional nipple sparing mastectomy and immediate gel implant breast reconstruction in the management of breast cancer—A case control comparison study with analysis of clinical outcome, medical cost, and patient-reported cosmetic results. J Plast Reconstr Aesthet Surg, 2020, 73(8): 1514-1525.
40. Huang JJ, Chuang EY, Cheong DC, et al. Robotic-assisted nipple-sparing mastectomy followed by immediate microsurgical free flap reconstruction: Feasibility and aesthetic results—Case series. Int J Surg, 2021, 95: 106143. doi: 10.1016/j.ijsu.2021.106143.
41. Park HS, Lee J, Lai HW, et al. Surgical and oncologic outcomes of robotic and conventional nipple-sparing mastectomy with immediate reconstruction: International multicenter pooled data analysis. Ann Surg Oncol, 2022, 29(11): 6646-6657.
42. Toesca A, Sangalli C, Maisonneuve P, et al. A randomized trial of robotic mastectomy versus open surgery in women with breast cancer or BrCA mutation. Ann Surg, 2022, 276(1): 11-19.
43. Lai HW, Chen DR, Liu LC, et al. Robotic versus conventional or endoscopic-assisted nipple-sparing mastectomy and immediate prosthesis breast reconstruction in the management of breast cancer: A prospectively designed multicenter trial comparing clinical outcomes, medical cost, and patient-reported outcomes (RCENSM-P). Ann Surg, 2024, 279(1): 138-146.
44. Lin YC, Lui SA, Chen MY, et al. Safety and feasibility of robotic nipple-sparing mastectomy with immediate direct-to-implant reconstruction—Insights from the one of the largest centers in Asia. Clin Breast Cancer, 2024 Dec 25: S1526-S8209(24)00364-1. doi: 10.1016/j.clbc.2024.12.013.
45. Lee SB, Kim J, Chung IY, et al. Use of the Da Vinci SP surgical system in robot-assisted nipple-sparing mastectomy: a single-center, retrospective study. Sci Rep, 2025, 15(1): 12. doi: 10.1038/s41598-024-84807-0.
46. Zhang S, Xie Y, Liang F, et al. Video-assisted transaxillary nipple-sparing mastectomy and immediate implant-based breast reconstruction: A novel and promising method. Aesthetic Plast Surg, 2022, 46(1): 91-98.
47. 周娇, 梁法清, 谢妍妍, 等. 华西医院日间腔镜乳腺皮下切除联合一期假体重建的临床路径简介. 中国胸心血管外科临床杂志, 2021, 28(12): 1393-1399.
48. 覃湘泉, 王甜甜, 谢妍妍, 等. 腋窝入路腔镜下乳腺癌皮下腺体切除联合胸肌前假体+补片Ⅰ期乳房重建的创新探索. 中国胸心血管外科临床杂志, 2021, 28(9): 1029-1036.
49. 海琳悦, 王雪菲, 刘博文, 等. 经腋窝单孔充气法乳腺腔镜手术治疗乳腺疾病的临床应用分析. 中国肿瘤临床, 2023, 50(5): 255-259.
50. 刘岩青, 崔磊, 方晓明, 等. 经腋窝单孔非溶脂全腔镜乳房皮下腺体切除联合假体乳房重建术的临床分析. 中华内分泌外科杂志, 2024, 18(2): 190-195.
51. Chung K, Xie Y, Liang F, et al. Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery. Front Oncol, 2024, 14: 1366877. doi: 10.3389/fonc.2024.1366877.
52. Dai H, Chung K, Liang F, et al. Safety and aesthetic outcomes of double purse-string suture nipple reconstruction in early breast cancer patients undergoing nipple resection and endoscopic skin-sparing mastectomy with breast reconstruction. Front Oncol, 2024, 14: 1462850. doi: 10.3389/fonc.2024.1462850.
53. Qiu M, Liang F, Xie Y, et al. Clinical outcomes of transaxillary reverse-sequence endoscopic nipple-sparing mastectomy and direct-to-implant prepectoral breast reconstruction: A prospective study of initial 68 procedures. Ann Surg Oncol, 2024, 31(4): 2777-2785.
54. Zhou J, Xie Y, Liang F, et al. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
55. 陈阔, 吕鹏威. 达芬奇机器人保留乳头乳晕乳腺切除即刻假体乳房重建术中预防热蒸汽损伤皮肤组织临床研究. 中国修复重建外科杂志, 2024, 38(7): 813-817.
56. Ramakrishnan VV, Southern S, Villafane O. Endoscopically assisted latissimus dorsi harvest and prosthetic placement. Br J Plast Surg, 1997, 50(3): 219-220.
57. Qiu J, Wen N, Xie Y, et al. Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery. Gland Surg, 2022, 11(8): 1383-1394.
58. Feng Y, Wen N, Liang F, et al. Endoscopic nipple- or skin-sparing mastectomy and immediate breast reconstruction with endoscopic harvesting of the latissimus dorsi flap: a preliminary experience of an innovative technique. Breast J, 2022, 2022: 1373899. doi: 10.1155/2022/1373899.

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