Feasibility and outcomes of single-incision robotic nipple-sparing mastectomy: a systematic review and meta-analysis

Single-incision robotic nipple-sparing mastectomy (RNSM) is an emerging minimally invasive approach for breast cancer and prophylactic surgery, yet its safety and feasibility remain to be confirmed. We conducted a comprehensive systematic review and meta-analysis to examine the single-incision RNSM perioperative parameters and complications. A bibliographic search was conducted according to the PRISMA guidelines across four databases. Following deduplication and exclusion, thirteen studies were eligible and constituted this study. Data were combined using random-effects models. Forest plots were generated to estimate pooled proportions using the Freeman-Tukey double arcsine transformation, and heterogeneity was assessed via I2 statistics. Quality assessment was performed using the Joanna Briggs Institute Checklist for Prevalence Studies. Funnel plots were used to assess publication bias. This study was registered on the PROSPERO registry. The pooled mean operative time was 273 min, and the mean blood loss was 82 ml. Pooled complication rates were relatively low, including skin-flap necrosis (2.4%), nipple-areolar complex necrosis (0.4%), delayed wound healing (4.7%), surgical-site infection (3.8%), deep infection (1.2%), hematoma (2.4%), and seroma (5.8%). Pooled estimate of positive margin rate was < 1%. Locoregional and distant recurrence rates were 0.8% and 0.4%, respectively. No conversions to open surgery or procedure-related deaths were reported. The single-incision RNSM is a modern surgical approach with acceptable perioperative parameters and satisfactory complication rates. However, heterogeneity across studies and the relative rarity of long-term oncological data warranted cautious interpretation. Prospective comparative trials are necessary to prove the oncological safety and economic effectiveness compared with other approaches.