Germans Trias i Pujol Hospital has just become the first hospital in Spain to perform a robot-assisted mastectomy. The public center in Badalona was chosen by Intuitive Surgical, an American company that developed the Da Vinci surgical platform, to test this type of intervention, taking into account that it causes fewer skin lesions and fewer postoperative complications, and has the same oncological safety as conventional surgery.
The first robotic mastectomies have been carried out on two patients who are already recovering satisfactorily at home after undergoing this surgical procedure, as well as an immediate breast reconstruction. "It has been a very wise decision, given how the operation went, the state of the removed tissue and how I am recovering," says one of them, a 45-year-old woman who had a large lesion in her left breast, a precursor to breast cancer ---which can evolve into breast cancer if not intervened--- and multiple lesions in both breasts. The second patient operated on, 55 years old, had a tumor in her right breast, which had already been affected by breast cancer years ago and had been removed.
Both patients are characterized by not being able to resort to a prosthesis with a graft of their own flesh ---extracted, basically, from abdominal fat---, so they required artificial prostheses. These implants, being made with foreign materials, can lead to postoperative complications, especially in conventional surgeries, in which a large incision is made and the mammary gland is removed with the use of hands and forceps, which also leaves the skin very damaged. The rejection that artificial prostheses can generate had been reduced with endoscopic mastectomies, which, through two small holes in the skin, allow the entry of a camera and surgical material to carry out the removal.
But, now, with the robotic platform tested in Can Ruti, the intervention can be further perfected. The improvement consists in that it is the robot that performs the force to extract the mammary gland, without reducing or increasing the intensity at any time, as can happen in laparoscopy, in which it is the surgeon who presses more or less. In addition, the robot does not need to lean on the patient to exert force when excising the mammary gland and executes it with greater precision.
All this allows for smaller wounds, less skin damage, and improved aesthetics, since the scar is limited to a minimal incision in the armpit. "It is another step in quality and safety," says Dr. Iciar Pascual from the Breast Pathology Unit of the Germans Trias Hospital.
Likewise, one of the benefits that robotic mastectomies can have is a lower loss of sensitivity in the breast, an issue that usually falls behind other factors, such as aesthetics, but also affects the recovery of patients. Still in the study phase, it is believed that, thanks to less manipulation and damage to the nerves of the breast, the areola and nipple can be maintained to a greater degree as erogenous zones. For now, one of the patients operated on in Can Ruti indicates that she already notices more sensitivity than expected in the breast. Other ongoing studies indicate that these minimally invasive operations can reduce free cancer cells in the blood.
After the success of these first two operations, the Badalona health center will begin to introduce the new mechanism into its daily routine, which does not improve oncological results, which are already sufficiently positive, with a survival close to 90%, but it does improve the quality of life of patients. It will be applied to all patients who meet the requirements to undergo this type of mastectomy. Basically, those who require an artificial prosthesis as they do not have enough fat for a graft.