Intraoperative complications and prevention strategies in robot-assisted breast surgery

Abstract

Robot-assisted breast surgery (RAS) improves cosmetic outcomes, but poses anatomical challenges-such as limited working space and lack of tactile feedback-that may increase intraoperative complication risk. To investigate the types and frequencies of intraoperative complications in RAS and assess preventive strategies employed by robotic breast surgeons based on their clinical experience, this Web-based survey was distributed to members of the Korea Robot-Endoscopy Minimal Access Breast Surgery Study Group. Twenty-six breast surgeons actively performing RAS responded to the questionnaire. The ten-item questionnaire was used to obtain data on surgeon demographics, RAS experience, intraoperative complications, and preventive strategies. The primary outcome was the prevalence of intraoperative complications; secondary outcomes included associations with surgeon experience and preventive strategies used. Among the 26 respondents, 80.8% (n = 21) reported at least one intraoperative complication during RAS. Patient-related complications included skin injury, brachial plexus palsy, incomplete breast tissue resection, and iatrogenic pneumothorax. Technical issues included CO₂ leakage and mechanical failure. All surgeons with > 50 cumulative RAS cases reported complications, whereas those with ≤ 20 cases reported none. This is the first study to systematically document intraoperative complications and preventive strategies in RAS in Korea. These findings offer valuable insights into complication patterns and practical prevention strategies that may inform surgical training, standardize practice, and improve patient safety in RAS.