Robotic-Assisted Lymphatic Supermicrosurgery for Breast Lymphedema-A Case Report and Literature Review.

Abstract

Abstract: Breast lymphedema, an often-overlooked complication of breast cancer treatment, affects nearly half of patients undergoing breast conservation surgery and responds poorly to conservative measures. While lymphaticovenous bypass (LVB) is a well-established intervention for extremity lymphedema, its application in breast lymphedema has been sporadic. We utilized microsurgical robot system in 1 patient to overcome the technical challenges of performing LVB in the breast.A 42-year-old woman developed progressive right breast swelling, heaviness, and pain following lumpectomy, sentinel lymph node biopsy, chemotherapy, and radiotherapy. Conservative measures failed to provide relief. Indocyanine green lymphography (ICGL) revealed normal lymphatic drainage in the arm but dermal backflow in the central and lower breast. Linear patterns in the upper outer quadrant, terminating near the axillary scar, were marked. Using a microsurgical robotic system, 2 end-to-end LVBs were performed through a single skin incision. Immediate postoperative decongestion was observed, with sustained symptomatic improvement at 6 months, evidenced by reduced pain scores and a significant decrease in the Lymphedema Life Impact Score. A literature review identified 6 reports describing 7 cases of LVB for breast lymphedema. The number of bypasses per breast ranged from 1 to 6, with 1 or 2 skin incisions, predominantly in the upper outer quadrant. All cases reported prompt subjective symptom relief, though objective measures were inconsistently applied.Our case demonstrates the first successful application of robotic-assisted LVB for breast lymphedema with significant improvement in clinical signs and symptoms as well as quality of life, based on validated patient-reported outcomes. Robotic assistance enhanced both the feasibility and ergonomics of performing supermicrosurgical LVB in the anatomically complex breast region.