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April 1, 2020

Robotic Mastectomy—Program Malfunction?

Author Affiliations
  • 1Department of Surgery, Washington University School of Medicine, St Louis, Missouri
JAMA Surg. 2020;155(6):461-462. doi:10.1001/jamasurg.2019.6361

Robotic-assisted nipple-sparing mastectomy was first reported in a cadaveric study conducted by Sarfati et al1 in 2016. Four fresh cadaveric breasts were used, and the authors reported that the procedure was feasible with complete mammary gland removal through a 4-cm axillary line incision.1 Soon after that initial report, other groups from Europe and Asia reported similar investigations in which patients were undergoing nipple-sparing mastectomy either for breast cancer prevention (in carriers of gene variations) or for treatment of newly diagnosed breast cancer.2-4 Currently, the use of the robot to assist in mastectomy procedures is not approved by the US Food and Drug Administration. Despite this, there have been isolated reports of robotic-assisted breast surgery in the US in the past 2 years. In response to these reports, the US Food and Drug Administration issued a statement on February 28, 2019, warning that the safety and effectiveness of robotic devices for mastectomy have not been established.

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    2 Comments for this article
    Compromised specimen extractions
    Harald Aanning, MD | Retired general surgeon
    Dr. Margenthaler's concern for the "oncologic integrity of the specimen on extraction" in robotic procedures is shared by others who worry about shedding cancer cells when "squeezing" such tissues through small incisions. Seems an appropriate issue for further investigation...
    Utility of robotic sugery
    Alton Thomson, MD | Retired Gynecologists
    Having practiced through the introduction of the robot to gynecology it seems to me that this, in many instances, is an instrument looking for it's place in the OR. The robot is primarily a marketing tool and not a surgical one.