Robotic Mastectomy – The Next Frontier in Breast Cancer Surgery

Robotic breast surgery is part of minimally invasive breast surgery techniques and can be considered a more advanced option when compared to endoscopic breast surgery. The use of the robotic surgical platform offers a system with greater precision and better ergonomics than standard laparoscopic/endoscopic systems.

Robotic breast surgery was first performed in 2015 in Italy and has since been performed in places such as France, South Korea, Taiwan, China, Japan and Hong Kong. There have been numerous studies published and the advantages of robotic breast surgery include but are not limited to: smaller incision/ scars resulting in lesser pain and faster recovery, and hidden scars leading to better aesthetic outcomes.

Both endoscopic and robotic breast surgery have been shown to result in better wound related satisfaction when compared to conventional surgery. In addition, oncological outcomes have been proven to be comparable to that of conventional breast surgery. This is reassuring, as oncological safety is of paramount importance in breast cancer treatment. There is no specific disadvantage ascribed to the technique itself, but additional cost in terms of consumables could be a limiting factor to its widespread adoption and availability.

In Singapore, the SingHealth Duke-NUS Breast Centre is proud to lead this field with Asst Prof Chi Wei Mok , Consultant, Division Of Breast Surgery, Department of Surgery, Changi General Hospital (CGH) as the lead Principal Investigator (PI) for the first pilot robotic mastectomy trial in Singapore and South East Asia, aptly named “Pilot Robotic Mastectomy in Singapore (PRoMiSing I) Study: First Safety and Feasibility Prospective Trial in South East Asia”. From December 2022 to December 2023, a total of 29 cases of robotic mastectomy were enrolled in CGH. The results of ProMiSing I demonstrated the safety of robotic mastectomy in our local population with excellent aesthetic outcomes. With such promising results, Asst Prof Mok and his team are currently recruiting patients for a long-term prospective cohort study: “Prospective Robotic Mastectomy in Singapore (PRoMiSing II) Study – Prospective Phase II Cohort Study on Long Term Outcomes Evaluations” to evaluate long-term oncologic and survival outcomes, as well as patient satisfaction.

The future is promising for the field of breast cancer surgery, as minimally invasive breast surgery techniques continue to demonstrate higher patient satisfaction while maintaining oncological safety. Asst Prof Mok shared that patient outcomes and satisfaction for patients who underwent minimally invasive breast surgery (endoscopic and robotic) in CGH since the Minimally Invasive Breast Surgery Service was set up in 2020 have been encouraging thus far. With greater empowerment and patient education, the demand for minimally invasive breast surgery will surely be on the upward trend, and CGH, as one of the key institutions under the SingHealth Duke-NUS Breast Centre, is proud to lead this along with our colleagues in Singapore General Hospital , Sengkang General Hospital , KK Women's and Children's Hospital and National Cancer Centre Singapore .

This article was first published in SurgeON Issue 28 (April - June 2024).