Ultrasound-guided, indocyanine green-directed robot-assisted surgery for breast cancer with negative margins: A single center study.

[OBJECTIVE] This pilot study evaluated the feasibility of a novel technique combining ultrasound-guided and indocyanine green (ICG) intra-tumoral injection with robot-assisted surgery to enable accurate local excision (lumpectomy) for breast cancer.

[BACKGROUND] Robot-assisted breast surgery has been used for nipple-sparing mastectomy for breast cancer; however, there are few published data on robot-assisted lumpectomy.

[METHODS] A novel surgical technique combined intraoperative ultrasound and indocyanine green (ICG) injections was developed to delineate narrow surgical excisions in 63 breast cancer patients by a single surgeon with precisely timed robotic-assisted excision. The surgical margins were assessed pathological with intraoperative frozen section examination. ICG-marked tumor boundaries were identified with clips and later evaluated using permanent sections. All patients underwent postoperative breast irradiation.

[RESULTS] The study demonstrated the specific timing with ICG diffusion throughout tumors after 3.3 ± 0.9 min before surgical excision. Total operating time averaged 192.9 ± 28.5 min, including sentinel lymph node biopsy or axillary lymph node dissection when indicated. The robotic lumpectomy component averaged 46.4 ± 10.5 min of console time. Notably, the surgical outcomes were successful with negative margins by frozen section examination in all 63 patients (100%). Analysis of ICG-guided surgical margins by permanent sectioning showed negative pathological margins in 62 of 63 specimens (98.4%).

[CONCLUSION] This surgical study represents one of the first demonstrations of a novel surgical technique with potential to reduce reoperation rates. The technique offers particular advantages for patients with larger, deeper breast tumors, potentially achieving results without visible breast scarring. Although the initial findings from this single institution are promising, multi-institutional studies are needed both the reproducibility of the technique and its long-term oncological outcomes.