Robot Assisted Breast Surgery

The present-era breast cancer treatment involves retaining as much of the original breast tissue as possible. The current treatment best practices around Breast Surgery are focused on having a functional breast after breast cancer treatment. However, this desired functionality of the breast depends on the amount of original skin and nipple preserved after cancer removal. The surgical procedure is termed as Skin Sparing / Nipple Sparing resections. It can end up completely removing malignant breast tissues or partially removing the suspicious malignant tissue with adequate margins. This calls for precision and technique best applied using robotic technology. 

This is a minimally invasive surgical technique which utilises robotic technology to perform breast surgery with increased precision and control. It involves using a robotic system, controlled by a surgeon, to assist in the removal of breast tumours or in breast reconstruction procedures. This approach offers benefits such as smaller incisions, reduced scarring, and potentially faster recovery times.

A large number of Breast Cancer patients are now eligible for such surgeries. Skin Sparing (SSM)/ Nipple Sparing Resections(NSM) provide at-par cancer control when compared with Radical Mastectomy in patients. This surgery is applicable to the following types of patients:

• Early-stage breast cancer patients with tumour size of approx. 5 cm, where the cancer has not spread to overlying skin and muscle. 
• Advanced breast cancer patients are administered Neo-Adjuvant Systemic Therapy which may include a combination of Chemotherapy, Targeted Therapy/Immunotherapy & Hormonal Therapy. Patients who respond well to NeoAdjuvant Treatment become eligible for SSM/NSM. 

Robotic Assistance helps provide even better results and breast functionality while doing SSM/ NSM procedures. 

Who is Eligible for Robotic-Assisted Breast Surgery?

• Individuals with a higher risk of breast cancer.
• Patients with early-stage breast cancer.
• Individuals with tumours less than 5 cm in Size.
• Patients seeking breast reconstruction.
• Patients with small to moderate breast size. 
• Individuals without extensive skin or chest wall involvement.

Our cutting-edge robotic technology enhances surgical precision with a unique set of robotic arms, overseen by skilled surgeons. This AI equipped 4th Gen technology helps:

• Execute procedures under expert supervision.
• Provide precise cutting and milling capabilities.
• Enhance clinical efficiency with utmost accuracy.
• Reduce the need for repeat surgeries and 
• Eliminate unwanted complications associated with delicate regions like the breast. 

About - Da Vinci Robot 

The da Vinci robotic system is an advanced robotic platform that allows surgeons to perform complex minimally invasive procedures with precision & accuracy. The da Vinci surgical system is one of the most widely used surgical systems in the world for surgeries in oncology, urology, gynaecology, general surgery, and more. The surgical system is widely preferred for its 3D HD vision, 10x magnification, surgeon console, tremor elimination, and more. 

• Camera arm and four mechanical arms with fine surgical instruments.
• Surgical console for precise control.
• High-definition, 3D view of the surgical site.
• Surgeon-controlled robotic arms with wristed articulation.
• Intelligent feedback for optimised surgical manoeuvres.
• Fourth-generation robotic instrument arms for seamless multi-port procedures.
• Universal arm design for flexible endoscope insertion.
• Longer instruments and thinner arms for enhanced precision and reduced collision risk in delicate areas.

The Procedure:

A highly precise surgery for breast reconstruction called Oncoplastic Breast Preservation, is gradually being performed using robot-assisted technology due to the quicker recovery and finer precision.

The Planning:

• The case will highlight the approach towards the treatment which will be arrived at after performing scans and initial treatment
• Oncoplastic Breast Preservation can be approached in two ways:
  Volume Displacement: reshaping and realigning breast tissue to form the Neo Breast
  Volume Replacement: harvesting tissues from the body to fill complete or partial mastectomy defects.
• For the volume replacement approach, a Latissimus tissue (LD flap) from the lateral and posterior back area is usually harvested. For this, a long incision is placed in the back, and the patient has to be repositioned and redraped the majority of times.
• Once the approach is decided the procedure is communicated to the patient and the surgery is prepped. 

The Execution:

• The patient is synced with the robotic system and stabilised for surgery.
• Surgical ports are introduced to the patient terminal, providing a 3D view of the surgeon's camera console.
• Surgeons perform the surgery while the AI replicates their movements on the patient's end.
• Robotic AI continuously reviews the procedure in real time, assisting the surgeon by making accurate cuts with the robotic arm.

According to Dr Toesca from Milan, one of the world’s most experienced Robotic Breast Surgeons, robotic assistance to perform Skin sparing / Nipple-sparing procedures ensures substantial medical advantages:

• Robotic arms provide better access at angles which is not possible with retractors in open methodology.
• Enhanced Vision leads to precision dissection using the 3D Image Console.
• Incision placement in skin creases like axillary(lateral) or inferior mammary achieves superior aesthetics than conventional skin-sparing procedures.
• Skin flap Vascularity is better preserved by minimising counter traction and incision planning.

A Robotic System is a fully automated, active technology. It offers multiple benefits to both the surgeon and the patient. Since Breast Surgery is a more delicate region, it provides a much enhanced clinical outcome with robotic assistance, such as: 

• Access to the back (thorax) through the axilla, hence avoiding the incision and scar at the back and eliminating the need to reposition and redrape as done traditionally.
• 3D – magnified view and resolution help ensure improved ergonomics and better access to the thorax thereby simplifying the surgical procedure. 
• Robotic assistance decreases surgical time to half and also eliminates the occurrence of posterolateral thoracic scar which is common in traditional approaches.
• Robot-Assisted LD Flap is a safer and more effective procedure which offers precise dissection with refined aesthetics.

Benefits of Robotic-Assisted Breast Surgery

• Less visible scarring is due to the minimally invasive nature.
• Robotic-assisted breast surgery allows for enhanced precision in suturing.
• Robotic systems like da Vinci allow for 3D vision & precise control of movements.
• The average hospital stay is reduced to 1-2 days with robotic-assisted breast surgery.
• Studies indicate that robotic-assisted surgery reduces the risk of complications by 25%.

• Better Visual Precision: Robotic assistance surgery provides 3D, high-definition, 10x magnified views that allows surgeons to see through the complex structures clearly. Plus better visual precision allows for preserving nerves and vessels.

• Better Access in Complex Areas: Robotic systems like da Vinci systems allow entry through smaller incisions into tight areas without damaging the skin or muscles.

• Wider Range of Motion: Using a robotic system allows for a wider range of motion compared to human hands. Also, given that robotic arms can bend and rotate more, it enables better manoeuvrability in confined spaces

• More Surgical Accuracy: The robotic arms translate the surgeon's arm movement into precise and tremor free motions ideal for delicate tissue removal.

• Better Reconstruction Planning: Robotic assistance can help preserve more of the breast’s skin and structure through robotic technique that makes aesthetic reconstruction smoother and more effective.

The CK Birla Hospital employs state-of-the-art surgical techniques to improve your quality of life. Surgeons can now seamlessly conduct vital procedures with enhanced ease, flexibility, accuracy, and precision, all thanks to the latest advancements in technology, ensuring optimal clinical results.

Highlights of Robotic Surgery

• Multidisciplinary team approach.
• Innovation-driven healthcare solutions.
• Fast and comprehensive recovery.
• World-class physiotherapy support.
• End-to-end rehabilitation support post-surgery as applicable.

Meet The Surgeon

Dr Mandeep Singh Malhotra is an experienced oncologist with decades of experience, especially with complex breast and head‑neck cancer surgeries, advanced reconstruction, and precision oncology. Dr Mandeep is also recognised as one of India’s pioneers in using the da Vinci surgical system for robotic-assisted breast preservation and head & neck oncology. Dr Mandeep is a certified TORS (transoral robotic surgery) surgeon using precise robotic-assisted surgery for tongue/oral/throat/thyroid cancers.