Advanced Breast Cancer Surgery With Robot-Assisted Technology
Background
A 28-year-old new mom was diagnosed with an advanced stage of breast cancer. She was treated with systemic therapy consisting of chemotherapy with Anti Her 2 Neu targeted drugs, supported by high-dose IV Vitamin C and natural supplements. She had a very good response to systematic therapy and was keen to be cured of her breast cancer with minimal mutilation.
Investigation & Analysis
Post the Neo Adjuvant treatment, a PET CT scan was performed. Upon review, the primary tumour site as well as the regional lymph nodes showed no active disease. The surgery was subsequently planned.
Treatment & Management
Dr Mandeep S Malhotra and his team from the CK Birla Hospital, Gurgaon, meticulously planned the surgery in the following steps to eliminate the cancer tissue and reconstruct the breast back to its original size and shape:
Step 1: Sentinel Lymph Node evaluation of axillary disease
Step 2: Robot-assisted skin-sparing resection of the primary tumour site
Step 3: Robot-assisted Latissimus tissue harvesting for reconstruction
Step 4: Latissimus tissue inserted in Sentinel Lymph Node (SLN) evaluation helps determine if cancer has spread to the lymph nodes in the axilla (armpit).
The sentinel lymph node is the first lymph node to which cancer cells are likely to spread from the primary tumor. A skin-sparing mastectomy is a surgical procedure commonly used in breast cancer treatment. The breast tissue is removed while preserving as much of the overlying skin as possible. Using robotic assistance, we were able to perform the surgery with minimal scarring, higher precision, and no skin necrosis.
Robotic assistance allowed us to harvest Latissimus dorsi tissue through an axillary incision only, thus avoiding any scar on the back and saving a lot of time in repositioning. The latissimus dorsi is a large muscle in the back, and its tissue, along with its blood vessels, can be relocated to the chest to reconstruct a natural-looking breast Using this step-by-step process, the team performed the surgery successfully, maintaining complete cosmetic aesthetics
Post Operative Care
We assisted the patient with subsequent dressing and precautionary measures to be considered post-surgery, helping her resume her motherhood sooner without compromising her appearance.
Robotic assistance was instrumental in performing this highly delicate surgery. It preserved the original breast skin without any ischemia and loss of sensation. It avoided the unsightly incision on the back. The latissimus tissue was harvested from the axilla and brought to fill the breast defect. The patient came in with breast cancer and walked out cancer-free with the same functional breast in just 24 hours.
