Single-port robot-assisted nipple-sparing mastectomy: a systematic review
In brief
Single-port robot mastectomy adds ~1 hour surgery time, keeps nipple loss under 2%
Across 16 studies, the single-port robot-assisted nipple-sparing mastectomy was always completed without converting to open surgery and showed nipple-areolar necrosis rates of only 1-2%. Operative time was about 54-70 minutes longer than conventional surgery, while serious complication rates ranged from 2-20% and short-term cancer outcomes appeared comparable. Long-term oncologic safety remains unproven, so use should stay in trial settings.
- Journal
- Journal of robotic surgery (Q1)
- Published
- 6 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Amaury Poque, Megane Geoffray, Lobna Ouldamer
- PMID
- 42557447
- DOI
- 10.1007/s11701-026-03752-4
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 9 August 2026).
- Picked for Health Informatics (top studies of the week, 9 August 2026).
Abstract
Single-port robot-assisted nipple-sparing mastectomy (SPRNSM) has emerged as an innovative minimally invasive alternative to conventional and multi-port robotic techniques, aiming to improve cosmetic outcomes while maintaining oncologic safety. This systematic review evaluates the feasibility, safety, and current evidence supporting SPRNSM. A systematic search of PubMed, the Cochrane Library, and ClinicalTrials.gov was conducted from database inception to July 4, 2026. Studies involving adult women undergoing SPRNSM for therapeutic or prophylactic indications were included. Both clinical and cadaveric studies reporting relevant outcomes were eligible. Study selection and data extraction were performed independently by two reviewers. Risk of bias was appraised using the ROBINS-I tool. Due to heterogeneity, results were synthesized narratively. Sixteen studies were included, comprising seven retrospective studies, one prospective study, five case reports, two case series, and one cadaveric study. SPRNSM was technically feasible across all studies, with no reported conversions to conventional surgery. Operative times were significantly longer than conventional nipple-sparing mastectomy (mean differences of 54-70 min) but comparable to multi-port robotic approaches. Grade III or higher complications ranged from 1.8% to 20%, with reoperation rates from 1.4% to 7.5%. Nipple-areolar complex necrosis rates were consistently low (1.2%-2.5%) and patient-reported satisfaction and sensory preservation were favorable. Short-term oncological outcomes appeared comparable to conventional techniques, although follow-up was limited to a maximum of 36 months. Overall risk of bias was serious for 80% of clinical studies. Current evidence suggests that SPRNSM is a feasible and safe procedure with potential cosmetic and functional advantages. However, the evidence base is limited by predominantly retrospective designs, small sample sizes, selection bias toward high-volume centers, and short follow-up, preventing definitive conclusions regarding long-term oncologic safety. SPRNSM represents a promising evolution in minimally invasive breast surgery; however, until long-term oncologic data become available, its use should remain limited to controlled settings and prospective trials. Ongoing randomized trials are expected to provide higher-level evidence in the coming years.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.