Efficacy and safety of endoscopic versus robotic axillary lymph node dissection in patients with node-positive breast cancer: a comparative retrospective study

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Robotic surgery for breast cancer is increasingly being adopted, but the evidence on its effectiveness and safety remains limited. This study aimed to compare the surgical quality and short-term outcomes of robotic and endoscopic axillary lymph node dissection in patients with node-positive breast cancer. Here we report the short-term outcomes of this trial. Methods. This single-center retrospective study compared the short-term efficacy and safety of endoscopic (E-ALND) and robotic (R-ALND) axillary lymph node dissection in patients with node-positive breast cancer. Patients were recruited from those who underwent surgery at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2022 and October 2024. Clinical and pathological characteristics, surgical outcomes, and postoperative complications were analyzed. Results The study included 56 patients, with 29 undergoing E-ALND and 27 undergoing R-ALND. The R-ALND group had significantly shorter surgical times (43.37 ± 12.40 min vs. 60.10 ± 19.37 min, p < 0.001) and lower mean blood loss (3.26 ± 2.40 ml vs. 9.24 ± 4.29 ml, p < 0.001). Postoperatively, the R-ALND group had better upper limb function and sensation, with significantly lower DASH scores at 1-month (10.87 ± 1.35 vs. 14.64 ± 3.49, p < 0.001) and 3-month (6.68 ± 1.86 vs. 9.24 ± 2.74, p < 0.001) follow-ups. The R-ALND group also had fewer postoperative complications, including a lower incidence of reduced sensation, burning sensation, and numbness in the upper limb. Conclusion Compared with E-ALND, R-ALND significantly reduces intraoperative bleeding and postoperative complications, resulting in better upper limb function and sensation. These findings suggest that R-ALND may offer superior clinical outcomes for patients undergoing axillary lymph node dissection for breast cancer. Robotic Surgery Endoscopic Surgery Axillary Lymph Node Dissection Breast Cancer Minimally Invasive Techniques Figures Figure 1 Introduction Breast cancer is a prevalent malignant tumor among women, characterized by high incidence and mortality rates [ 1 ]. For patients initially diagnosed with breast cancer without systemic metastasis, the treatment plan must consider the tumor size (T stage) and whether there is lymph node metastasis (N stage) [ 2 ]. When axillary lymph node metastasis occurs, axillary lymph node dissection is a necessary step in breast cancer surgery and a crucial step in determining tumor staging, which is essential for devising a treatment plan and assessing prognosis [ 3 ]. However, complications associated with axillary lymph node dissection (ALND) include lymphedema, wound infection, fat necrosis, altered arm sensation, and limited range of motion [ 4 ]. With the advent of minimally invasive techniques, endoscopic technology has increasingly been integrated into breast cancer treatment protocols [ 5 ]. This approach offers an enlarged and more precise visual field, thereby mitigating damage to microstructures. Studies have reported the effectiveness and safety of endoscopic axillary lymph node dissection (E-ALND) [ 6 ]. Nonetheless, the current evidence of research results comes from low-quality, small-scale randomized controlled trials, and there is a lack of multicenter prospective clinical studies. Therefore, the effectiveness and safety of E-ALND remain controversial. Compared to endoscopic surgery, robotic surgery offers several advantages, including an enlarged 3D surgical view and more stable surgical manipulation. The robotic arms are equipped with wrist-like joints that have seven degrees of freedom, allowing for 540° rotation and precise manipulation within a very small area. Studies have reported the application of robotic surgery in lymph node dissection, including retroperitoneal, cervical, or inguinal lymph node dissection [ 7 – 10 ]. The robotic surgery system enables surgeons to access narrower surgical sites and more clearly distinguish microstructures, thereby enhancing the precision and safety of the surgery. Theoretically, robotic surgery may be particularly suitable for axillary lymph node dissection. Given the higher cost of robotic surgery compared to endoscopic surgery, there is a need for clear evidence to support its clinical application. However, there is currently a scarcity of studies focusing on robotic axillary lymph node dissection (R-ALND), and a lack of comparison between endoscopic and robotic axillary dissection. Therefore, in this study, we compared the short-term efficacy and safety of endoscopic and robotic axillary lymph node dissection in breast cancer patients. Patient Enrollment Patients were recruited from those who underwent single-port E-ALAD and R-ALND for breast cancer at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2022 and October 2024. A total of 29 patients who underwent E-ALND and 27 patients who underwent R-ALND were included in this study. The study was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University. Written informed consent was obtained from each patient prior to their participation. Clinical and pathological characteristics, including age, estrogen receptor (ER) status, progesterone receptor (PR) status, HER2 status, Ki-67 index, histological grade, tumor size, TN staging, and the implementation of neoadjuvant chemotherapy, were included in the analysis. Surgical outcomes, including the number of axillary lymph nodes dissected, the number of positive axillary lymph nodes, operative time, intraoperative blood loss, and postoperative complications such as postoperative upper limb function, wound infection, seroma, and lymphedema, were also analyzed. The inclusion/exclusion criteria for patients were selected based on the following demographic characteristics and tumor characteristics. Inclusion criteria: 1) Age 18–75 years; 2) Pathologically confirmed breast cancer (BC); 3) Positive axillary lymph nodes. Exclusion criteria: 1) Presence of distant metastasis; 2) Inability to tolerate surgery due to cardiopulmonary dysfunction; 3) Concurrent other malignant tumors. Surgical Procedure For R-ALND, an incision is made on the lateral chest wall with minimal dissection to facilitate the creation of a surgical cavity. A single-port four-channel trocar is inserted, followed by three 8mm trocars. The da Vinci Xi robotic arms are then connected to these trocars, and the cavity is insufflated to maintain an intra-abdominal pressure of 8–10 mmHg. The R-ALND follows a systematic "bottom-up, back-to-front" approach. The dissection begins at the lower posterior wall of the axilla and proceeds superiorly, then moves to the medial wall, lateral wall, central axilla, and finally the apex of the axilla. 1) Axillary Floor Dissection: The procedure starts with the dissection of the axillary floor, where the reticulated fascia is separated to identify and protect the lowest intercostobrachial nerve. 2) Posterior Wall Dissection: The dissection proceeds medially to isolate the anterior branch of the thoracodorsal vessels, continuing until the main trunk of the thoracodorsal vessels is reached. Subsequently, the dissection moves laterally to separate the circumflex scapular vessels, extending until the point where the thoracodorsal vein joins the axillary vein. 3)Medial Wall Dissection: The medial wall is carefully dissected to protect the thoracodorsal nerve anterior to the serratus anterior muscle. CO2 insufflation is utilized to dissect along the membrane space superiorly towards the axillary vein angle, which is the uppermost part of the axilla. 4) Lateral Wall Dissection: The lateral wall is dissected along the outer side of the intercostobrachial nerve to visualize the axillary vein. 5) Anterior Wall Dissection: The anterior wall is dissected with attention to protecting the medial cutaneous nerve of the arm. The dissection follows the axillary vein from lateral to medial. 6) Intercostobrachial Nerve Dissection: The intercostobrachial nerve at the level of the axillary vein is dissected from medial to lateral, separating the upper and lower layers of axillary tissue to preserve the nerve. The lowest intercostal nerve, being finer, may be transected during this process. 7) Lymph Node Clearance and Irrigation: After thorough dissection and complete clearance of the axillary lymph nodes, the cavity is irrigated with warm distilled water, and drains are placed to ensure proper postoperative management. E-ALND: A 5cm incision was made at the lateral edge of the chest and 2-3cm was separated from the subcutaneous tissue around the incision for insertion of a disposable incision fixator. The port of the single-hole cavity mirror covers the outer mouth of the notched fixator to maintain the air pressure in the cavity at 8mmHg. The procedure is consistent with R-ALND. Evaluation of postoperative upper limb function Range of Motion (ROM) of the shoulder joint was collected at baseline and 3 months postoperatively. The shoulder joint ROM consists of three components: abduction, flexion, and horizontal abduction. Based on our clinical experience, a goniometer was used to measure the ROM for all subjects. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a widely used standardized assessment tool for upper limb function. It is a patient-reported outcome measure that includes a core set of 30 questions, 23 of which assess upper limb function and 7 assess symptoms, including pain (at rest, during activity, and at night), strength, and stiffness. The DASH score is calculated by summing the scores of the 30 items and then applying the following formula: DASH score = (Total sum of the 30 items − 30 [minimum score]) / 1.20. This transformation scales the raw score to a range of 0 to 100, where 0 indicates normal upper limb function and 100 indicates severe impairment. Statistical analysis Continuous variables were analyzed using the Mann-Whitney U test and are reported as medians with their respective minimum and maximum ranges. Categorical variables were compared using Fisher's exact test. All statistical analyses were performed using SPSS software. A p-value of less than 0.05 was considered statistically significant. Results Patient characteristics A retrospective analysis was conducted on the medical records of 136 patients who underwent ALND at our center from January 2022 to October 2024. After applying the inclusion and exclusion criteria, 70 patients from the conventional surgery group were excluded, resulting in the inclusion of 56 patients. Of these, 29 underwent E-ALND, and 27 underwent R-ALND (Fig. 1 ). The demographic and clinical characteristics of the patients are summarized in Table 1 . There was no statistically significant difference in age between the two groups (R-ALND group: 55.83 ± 14.89 vs. E-ALND group: 49.81 ± 10.4, P = 0.084). No statistically significant differences were observed between the two groups in terms of pathological staging, hormone receptor status, HER2 status, Ki-67 expression, histological grading, preoperative chemotherapy, or type of breast surgery. Table 1 Clinicopathologic characteristics of E-ALND and R-ALND Variables Mean ± SD or n (%) E-ALND (n = 29) R-ALND (n = 27) P value Age (Y) 55.83 ± 14.89 49.81 ± 10.40 0.084 Pathologic stage 0.556 I 3 (10.3%) 2 (7.4%) II 15 (51.7%) 18 (66.7%) III 11 (38.0%) 7 (25.9%) Estrogen receptor 0.570 Negative 9 (31.1%) 8 (29.6%) Positive 20 (68.9%) 19 (70.3%) Progesterone receptor Negative 13 (44.9%) 11 (40.8%) 0.485 Positive 16 (55.1%) 16 (59.2%) HER2 status 0.424 Negative 20 (68.9%) 17 (62.9%) Positive 9 (31.1%) 10 (37.1%) Ki-67 0.266 14% 21 (72.4%) 15 (55.6%) Histological grade 0.892 1 1 (3.2%) 2 (7.4%) 2 23 (79.3%) 20 (74.0%) 3 5 (17.2%) 5 (18.6%) Preoperative chemotherapy 0.576 No 19 (65.5%) 18 (66.7%) Yes 10 (34.4%) 9 (33.3%) Breast surgery 0.398 Partial 13 (44.9%) 14 (51.8%) Total 16 (55.1%) 13 (48.1%) Abbreviations: E-ALND,endoscopic axillary lymph node dissection; R-ALND,robotic axillary lymph node dissection Comparison of surgical outcomes The mean operative time for the E-ALND group was significantly longer compared to the R-ALND group (60.10 ± 19.37 min vs. 43.37 ± 12.40 min, p < 0.001). Additionally, the R-ALND group had a significantly lower mean blood loss (3.26 ± 2.40 ml vs. 9.24 ± 4.29 ml, p < 0.001). During the postoperative recovery period, the total axillary drainage volume was 247.66 ± 198.42 ml for the E-ALND group and 192.48 ± 139.06 ml for the R-ALND group, with no statistically significant difference between the groups (p = 0.237). Although the postoperative axillary drain retention time was similar for both the E-ALND group (8.48 ± 3.65 days) and the R-ALND group (7.88 ± 2.51 days, p = 0.485), the R-ALND group had a significantly shorter postoperative hospital stay (9.03 ± 2.38 days vs. 10.69 ± 3.20 days, p = 0.033). Furthermore, there were no statistically significant differences between the two groups in the mean number of axillary lymph nodes dissected or the number of positive nodes (Table 2 ). Table 2 Surgical outcomes of E-ALND and R-ALND Variables Mean ± SD or n (%) E-ALND (n = 29) R-ALND (n = 27) P value Time for ALND (minutes) 60.10 ± 19.37 43.37 ± 12.40 < 0.001 Blood loss (ml) 9.24 ± 4.29 3.26 ± 2.40 < 0.001 Drainage flow (mL) 247.66 ± 198.42 192.48 ± 139.06 0.237 Duration of axillary drainage (d) 8.48 ± 3.65 7.88 ± 2.51 0.485 Post-operation hospital stay (d) 10.69 ± 3.20 9.03 ± 2.38 0.033 Number of lymph nodes harvested 17.13 ± 9.45 17.88 ± 6.66 0.734 Number of metastatic lymph nodes 3.14 ± 7.00 2.96 ± 4.88 0.915 Postoperative pain 0.008 No pain (PS = 0) 8 (27.6%) 17 (63.0%) Mild pain (PS = 1–3) 21 (72.4%) 10 (37.0%) Moderate to severe pain (PS ≥ 4) 0 (0%) 0 (0%) Abbreviations: E-ALND,endoscopic axillary lymph node dissection; R-ALND,robotic axillary lymph node dissection;PS，Pain score Table 3 Postoperative Clinical outcome of E-ALND and R-ALND Variables Mean ± SD or n (%) E-ALND (n = 29) R-ALND (n = 27) Complications Hemorrhage 0 0 Wound infection 0 0 Axillary seroma 0 0 Poor wound healing 1 0 Lymphorrhagia 2 0 Lymphedema of the upper limbs 0 0 Abbreviations: E-ALND,endoscopic axillary lymph node dissection; R-ALND,robotic axillary lymph node dissection; Table 4 Arm Morbidities in the two Groups Variables Mean ± SD or n (%) E-ALND (n = 29) R-ALND (n = 27) P value Shoulder Abduction Preoperative 178.27 ± 1.55 178.59 ± 1.31 0.415 At 3 months after surgery 165.75 ± 5.53 174.03 ± 5.35 < 0.001 Shoulder Flexion Preoperative 178.21 ± 1.66 178.29 ± 1.72 0.844 At 3 months after surgery 167.03 ± 4.62 173.04 ± 5.35 < 0.001 Shoulder Horizontal abduction Preoperative 37.97 ± 2.15 37.81 ± 2.20 0.796 At 3 months after surgery 30.07 ± 3.40 33.48 ± 3.99 0.001 DASH score Preoperative 0.56 ± 0.86 0.52 ± 0.85 0.852 At 1 months after surgery 14.64 ± 3.49 10.87 ± 1.35 < 0.001 At 3 months after surgery 9.24 ± 2.74 6.68 ± 1.86 < 0.001 Arm Function Hypesthesia 8 (27.6%) 1 (3.7%) 0.017 Burning sensation 6 (20.7%) 0 (0%) 0.015 Numb 8 (27.6%) 1 (3.7%) 0.017 Pain 3 (10.3%) 0 (0%) 0.132 Abbreviations: DASH, Disabilities of the Arm, Shoulder, and Hand Comparison of postoperative complications Neither the E-ALND nor the R-ALND group experienced postoperative bleeding or wound infection. One case of axillary hematoma occurred in the endoscopic group, which was successfully treated with aspiration and pressure dressing. Additionally, there was one case of poor wound healing and two cases of lymphatic leakage in the endoscopic group. Persistent pressure dressing in the axillary area was found to improve lymphatic leakage. In contrast, the robotic group had no occurrences of hematoma, poor wound healing, or lymphatic leakage. Postoperative upper limb function Before surgery, there was no statistically significant difference in shoulder abduction, shoulder flexion, and horizontal abduction ROM between the two groups. However, at the 3-month postoperative follow-up, the R-ALND group showed significantly greater ROM in shoulder abduction (174.03 ± 5.35° vs. 165.75 ± 5.53°, p < 0.001) and shoulder flexion (173.04 ± 5.35° vs. 167.03 ± 4.62°, p < 0.001) compared to the E-ALND group. Similarly, the horizontal abduction ROM also demonstrated a similar trend (33.48 ± 3.99° vs. 30.07 ± 3.40°, p = 0.001). Preoperatively, there was no significant difference in DASH scores between the two groups. However, at the 1-month postoperative follow-up, the R-ALND group had significantly lower DASH scores compared to the E-ALND group (10.87 ± 1.35 vs. 14.64 ± 3.49, p < 0.001). At the 3-month postoperative follow-up, upper limb function improved in both groups, but the R-ALND group still had lower DASH scores than the E-ALND group (6.68 ± 1.86 vs. 9.24 ± 2.74, p < 0.001). At the three-month postoperative follow-up, the E-ALND group reported a significantly higher incidence of reduced sensation (8 cases, 27.6%), burning sensation (6 cases, 20.7%), and numbness (8 cases, 27.6%) in the upper limb compared to the R-ALND group, which had only 1 case (3.7%) of reduced sensation and 1 case (3.7%) of numbness, with no cases of burning sensation. The differences between the two groups were statistically significant. However, there was no significant difference in postoperative upper limb pain between the two groups (3 cases, 10.3% in the E-ALND group vs. 0 cases, 0% in the R-ALND group, p = 0.132). These results suggest that the R-ALND group had a lesser impact on postoperative upper limb sensation and function, allowing for greater activity in the affected upper limb. Discussion We conducted a single-center retrospective case study to report the safety and efficacy of robotic surgery for axillary lymph node dissection compared to endoscopic axillary lymph node dissection. Endoscopic surgery has been widely applied in the treatment of breast cancer; however, its efficacy and safety remain a subject of debate. In an epidemiological study, the mortality rate for minimally invasive surgery in patients with stage IA2 or IB1 cervical cancer was significantly higher than that for open surgery (P = 0.002) [ 11 ]. A meta-analysis showed that patients undergoing minimally invasive radical hysterectomy had a 71% higher risk of recurrence and a 56% higher risk of death [ 12 ]. During endoscopic surgery, surgical instruments enter the axilla in a nearly vertical direction, with limited angles for horizontal manipulation, and the narrow space can easily lead to instrument interference. Additionally, endoscopic surgery requires an experienced assistant physician, which many medical centers lack. Overall, these factors affect the quality of endoscopic surgery. Although current studies have demonstrated the safety of E-ALND for breast cancer, there is still a lack of large-scale and prospective studies. Robotic surgery can overcome the limitations of endoscopic surgery. In fact, robotic instruments have multiple degrees of freedom, offering flexibility similar to a surgeon's hand, with even better stability. The magnified three-dimensional vision provides a more detailed surgical field, controlled by the surgeon, which can replace the role of an assistant in endoscopic surgery. These technical advantages make robotic surgery more accurate and convenient for axillary lymph node dissection. However, there are currently few studies reported on robotic axillary lymph node dissection, and no studies comparing endoscopic and robotic axillary lymph node dissection. In our study, robotic axillary lymph node dissection significantly reduced intraoperative bleeding, postoperative pain, and hospital stay duration. Additionally, robotic surgery had a lesser impact on postoperative upper limb function and sensation, allowing for greater activity in the affected upper limb. Reduced intraoperative bleeding can decrease surgical time and accelerate postoperative recovery. In our study, the R-ALND group had significantly shorter surgical times (43.37 ± 12.40 min vs. 60.10 ± 19.37 min, p < 0.001). Additionally, the mean blood loss in the R-ALND group was significantly lower (3.26 ± 2.40 ml vs. 9.24 ± 4.29 ml, p < 0.001). Compared to endoscopic surgery, the da Vinci robotic system offers a larger magnification of up to 10–15 times, providing a clearer and more detailed surgical field, which allows for the early identification of small vessels within the axillary field, thereby reducing intraoperative bleeding and enhancing the quality and safety of the surgery. The robotic surgery system can also reduce the shaking of the surgical field compared to the assistance provided by endoscopic surgery, offering a more stable surgical view. Surgeons can achieve higher precision and reduce intraoperative bleeding through a clearer and more stable surgical field provided by the robotic surgery system. The reduction in intraoperative bleeding results in a clearer surgical field, avoiding surgical errors caused by field contamination and reducing surgical complications. Similar observations can be made in studies comparing robotic and open axillary dissection, where robotic surgery can significantly reduce intraoperative bleeding [ 13 ]. During ALND, there is a risk of damaging the intercostobrachial nerve, which can lead to postoperative upper limb functional and sensory impairments. These impairments are challenging to treat and can cause psychological barriers, thereby affecting the patient's quality of life. The intercostobrachial nerve originates from the anterior branch of the second intercostal nerve and innervates the skin of the axillary region and lateral chest wall, controlling upper limb sensory functions. Its unique anatomical position, traversing the fatty tissue of the axillary region in a "natural space" between the anterior and posterior axillary wall fascia, makes it difficult to dissect intact, often resulting in intraoperative damage. Our study found that at the three-month postoperative upper limb sensory assessment, the robotic group had significantly fewer cases of upper limb sensory reduction (1 case, 3.7%), burning sensation (0 cases, 0%), and numbness (1 case, 3.7%) compared to the endoscopic group. This suggests that robotic surgery may offer better preservation of the intercostobrachial nerve, leading to fewer postoperative sensory impairments. Compared to endoscopic surgery, robotic surgery offers a more stable operation due to the absence of tremors in the robotic instruments, allowing surgeons to dissect the intercostobrachial nerve with greater precision and protection. In prostate cancer lymph node dissection, the deep location and narrow space of the male pelvis highlight the advantages of robotic surgery. Studies comparing robotic and endoscopic surgery have shown that robotic surgery better preserves pelvic nerves, significantly reducing the incidence of postoperative urinary retention [ 14 ]. Furthermore, robotic surgery systems feature instruments with 7 degrees of freedom and the ability to rotate 540°, due to their unique internal joint design. This makes robotic surgery more efficient than endoscopic surgery, as it can navigate around the intercostobrachial nerve to perform more delicate axillary dissections. Although the intercostobrachial nerve does not directly control upper limb joint movements, research indicates that preserving this nerve significantly reduces the risk of postoperative sensory abnormalities and neuropathic pain, facilitating upper limb functional recovery. Our study results also demonstrate that at one and three months postoperatively, patients in the robotic group had significantly better upper limb function compared to the endoscopic group (10.87 ± 1.35 vs. 14.64 ± 3.49, p < 0.001; 6.68 ± 1.86 vs. 9.24 ± 2.74, p < 0.001). This underscores the potential benefits of robotic surgery in enhancing postoperative outcomes. This study has certain limitations. Firstly, it is a single-center retrospective study with a small sample size. Secondly, due to the short follow-up period, this study only discusses the short-term efficacy and safety of robotic surgery, without conducting a long-term assessment of oncological safety. Moving forward, we will continue to follow up with patients and include a larger cohort to confirm the reliability of our findings. Conclusion Compared with E-ALND, R-ALND can significantly reduce intraoperative bleeding, have less impact on postoperative upper limb function and sensation, and have greater upper limb motion on the affected side. Declarations Conflicts of interest The authors declare that they have no conflicts of interest in this study. 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JAMA Oncol 6(7):1019–1027 [PMID: 32525511 PMCID: PMC7290695. 10.1001/jamaoncol.2020.1694] Chen K, N MB, Zhang J, Reshetov IV, Nikolenko VN, Sinelnikov MY, Mikhaleva LM (2021) Efficacy of da Vinci robot-assisted lymph node surgery than conventional axillary lymph node dissection in breast cancer - A comparative study. Int J Med Robot 17(6):e2307 [PMID: 34270843. 10.1002/rcs.2307] Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G (2002) Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 60(5):864–868 [PMID: 12429317 DOI: 10.1016/s0090-4295(02)01881-2] Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5787958","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":400015886,"identity":"2aee8285-f8af-44ea-b214-9ebfbd8c1175","order_by":0,"name":"Zhijie Wu","email":"","orcid":"","institution":"The Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Zhijie","middleName":"","lastName":"Wu","suffix":""},{"id":400015887,"identity":"28cd6a61-b2c7-4ae9-96b1-2acc831bc49b","order_by":1,"name":"Zongyan Li","email":"","orcid":"","institution":"The Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Zongyan","middleName":"","lastName":"Li","suffix":""},{"id":400015888,"identity":"d6adf819-6d65-433d-a645-89824d7a0489","order_by":2,"name":"Zuxiao Chen","email":"","orcid":"","institution":"The Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Zuxiao","middleName":"","lastName":"Chen","suffix":""},{"id":400015889,"identity":"07bdcbf6-df54-49ea-ab16-a8b61cbbe0a5","order_by":3,"name":"Xiaoyan Fu","email":"","orcid":"","institution":"The Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoyan","middleName":"","lastName":"Fu","suffix":""},{"id":400015890,"identity":"3e8c9dc4-0ab9-46a2-aa26-a2ef22cafe49","order_by":4,"name":"Ze Huang","email":"","orcid":"","institution":"The Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Ze","middleName":"","lastName":"Huang","suffix":""},{"id":400015891,"identity":"5204fdf3-234a-4aba-b400-caae27424e83","order_by":5,"name":"Yunxiang Luo","email":"","orcid":"","institution":"The Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Yunxiang","middleName":"","lastName":"Luo","suffix":""},{"id":400015892,"identity":"2cb30531-aed0-4a98-9fa1-b44eb8a2c1ea","order_by":6,"name":"Qiwen Liu","email":"","orcid":"","institution":"The Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Qiwen","middleName":"","lastName":"Liu","suffix":""},{"id":400015893,"identity":"9fab803f-f760-4a8d-a0c2-1af3ffdc95dd","order_by":7,"name":"Haiyan Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYBACPmYeBoaP/2wYGJiZG2CCBni1sAG1MM5gSwNqYSRWCwMPAzMP22Egk2gt7LzHJHh4zkfztzM2MP5sq0tsYG/eJsFQcwePw/jSJCQkbufOOMzYwMzbdjixgedYmQTDsWf4/GImYWBwO7cBpIWx7UBig0SOmQRjw2H8WhISzuXOPwxzmPwbIrQcOHAgdwNQCwNvGzPQFh6CWowtGxuSczcCtRzmOXfYuI0nrdgi4RhuLfz8Zwxv/22wy513/vDBhz/K6mT72Q9vvPGhBrcWIGCRgLEOMLKBYgoIEvBpAEb7BwT7D36lo2AUjIJRMDIBAHHsTx02AjD2AAAAAElFTkSuQmCC","orcid":"","institution":"The Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":true,"prefix":"","firstName":"Haiyan","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-01-08 10:08:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5787958/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5787958/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73703699,"identity":"1433254e-77c0-4aa5-8408-08a35896932d","added_by":"auto","created_at":"2025-01-13 17:44:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":47892,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of patient selection.\u003c/p\u003e\n\u003cp\u003eAbbreviations: E-ALND,endoscopic axillary lymph node dissection; R-ALND,robotic axillary lymph node dissection;C-ALND, conventional axillary lymph node dissection\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5787958/v1/ca95bda55b6c01f7fd90e2b0.png"},{"id":73802011,"identity":"e93c6c39-1190-4a18-b0fb-a26b8a31420c","added_by":"auto","created_at":"2025-01-14 21:01:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":875119,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5787958/v1/f4fbd246-5da3-4ed1-bb77-2591ba486fab.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Efficacy and safety of endoscopic versus robotic axillary lymph node dissection in patients with node-positive breast cancer: a comparative retrospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast cancer is a prevalent malignant tumor among women, characterized by high incidence and mortality rates [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. For patients initially diagnosed with breast cancer without systemic metastasis, the treatment plan must consider the tumor size (T stage) and whether there is lymph node metastasis (N stage) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. When axillary lymph node metastasis occurs, axillary lymph node dissection is a necessary step in breast cancer surgery and a crucial step in determining tumor staging, which is essential for devising a treatment plan and assessing prognosis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, complications associated with axillary lymph node dissection (ALND) include lymphedema, wound infection, fat necrosis, altered arm sensation, and limited range of motion [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. With the advent of minimally invasive techniques, endoscopic technology has increasingly been integrated into breast cancer treatment protocols [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This approach offers an enlarged and more precise visual field, thereby mitigating damage to microstructures. Studies have reported the effectiveness and safety of endoscopic axillary lymph node dissection (E-ALND) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Nonetheless, the current evidence of research results comes from low-quality, small-scale randomized controlled trials, and there is a lack of multicenter prospective clinical studies. Therefore, the effectiveness and safety of E-ALND remain controversial.\u003c/p\u003e \u003cp\u003eCompared to endoscopic surgery, robotic surgery offers several advantages, including an enlarged 3D surgical view and more stable surgical manipulation. The robotic arms are equipped with wrist-like joints that have seven degrees of freedom, allowing for 540° rotation and precise manipulation within a very small area. Studies have reported the application of robotic surgery in lymph node dissection, including retroperitoneal, cervical, or inguinal lymph node dissection [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e–\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The robotic surgery system enables surgeons to access narrower surgical sites and more clearly distinguish microstructures, thereby enhancing the precision and safety of the surgery. Theoretically, robotic surgery may be particularly suitable for axillary lymph node dissection. Given the higher cost of robotic surgery compared to endoscopic surgery, there is a need for clear evidence to support its clinical application. However, there is currently a scarcity of studies focusing on robotic axillary lymph node dissection (R-ALND), and a lack of comparison between endoscopic and robotic axillary dissection. Therefore, in this study, we compared the short-term efficacy and safety of endoscopic and robotic axillary lymph node dissection in breast cancer patients.\u003c/p\u003e\n\n \n\n "},{"header":"Patient Enrollment","content":"\u003cp\u003ePatients were recruited from those who underwent single-port E-ALAD and R-ALND for breast cancer at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2022 and October 2024. A total of 29 patients who underwent E-ALND and 27 patients who underwent R-ALND were included in this study. The study was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University. Written informed consent was obtained from each patient prior to their participation.\u003c/p\u003e\u003cp\u003eClinical and pathological characteristics, including age, estrogen receptor (ER) status, progesterone receptor (PR) status, HER2 status, Ki-67 index, histological grade, tumor size, TN staging, and the implementation of neoadjuvant chemotherapy, were included in the analysis. Surgical outcomes, including the number of axillary lymph nodes dissected, the number of positive axillary lymph nodes, operative time, intraoperative blood loss, and postoperative complications such as postoperative upper limb function, wound infection, seroma, and lymphedema, were also analyzed.\u003c/p\u003e\u003cp\u003eThe inclusion/exclusion criteria for patients were selected based on the following demographic characteristics and tumor characteristics. Inclusion criteria: 1) Age 18–75 years; 2) Pathologically confirmed breast cancer (BC); 3) Positive axillary lymph nodes. Exclusion criteria: 1) Presence of distant metastasis; 2) Inability to tolerate surgery due to cardiopulmonary dysfunction; 3) Concurrent other malignant tumors.\u003c/p\u003e\u003ch2\u003eSurgical Procedure\u003c/h2\u003e\u003cp\u003eFor R-ALND, an incision is made on the lateral chest wall with minimal dissection to facilitate the creation of a surgical cavity. A single-port four-channel trocar is inserted, followed by three 8mm trocars. The da Vinci Xi robotic arms are then connected to these trocars, and the cavity is insufflated to maintain an intra-abdominal pressure of 8–10 mmHg.\u003c/p\u003e\u003cp\u003eThe R-ALND follows a systematic \"bottom-up, back-to-front\" approach. The dissection begins at the lower posterior wall of the axilla and proceeds superiorly, then moves to the medial wall, lateral wall, central axilla, and finally the apex of the axilla. 1) Axillary Floor Dissection: The procedure starts with the dissection of the axillary floor, where the reticulated fascia is separated to identify and protect the lowest intercostobrachial nerve. 2) Posterior Wall Dissection: The dissection proceeds medially to isolate the anterior branch of the thoracodorsal vessels, continuing until the main trunk of the thoracodorsal vessels is reached. Subsequently, the dissection moves laterally to separate the circumflex scapular vessels, extending until the point where the thoracodorsal vein joins the axillary vein. 3)Medial Wall Dissection: The medial wall is carefully dissected to protect the thoracodorsal nerve anterior to the serratus anterior muscle. CO2 insufflation is utilized to dissect along the membrane space superiorly towards the axillary vein angle, which is the uppermost part of the axilla. 4) Lateral Wall Dissection: The lateral wall is dissected along the outer side of the intercostobrachial nerve to visualize the axillary vein. 5) Anterior Wall Dissection: The anterior wall is dissected with attention to protecting the medial cutaneous nerve of the arm. The dissection follows the axillary vein from lateral to medial. 6) Intercostobrachial Nerve Dissection: The intercostobrachial nerve at the level of the axillary vein is dissected from medial to lateral, separating the upper and lower layers of axillary tissue to preserve the nerve. The lowest intercostal nerve, being finer, may be transected during this process. 7) Lymph Node Clearance and Irrigation: After thorough dissection and complete clearance of the axillary lymph nodes, the cavity is irrigated with warm distilled water, and drains are placed to ensure proper postoperative management.\u003c/p\u003e\u003cp\u003eE-ALND: A 5cm incision was made at the lateral edge of the chest and 2-3cm was separated from the subcutaneous tissue around the incision for insertion of a disposable incision fixator. The port of the single-hole cavity mirror covers the outer mouth of the notched fixator to maintain the air pressure in the cavity at 8mmHg. The procedure is consistent with R-ALND.\u003c/p\u003e\u003ch3\u003eEvaluation of postoperative upper limb function\u003c/h3\u003e\u003cp\u003eRange of Motion (ROM) of the shoulder joint was collected at baseline and 3 months postoperatively. The shoulder joint ROM consists of three components: abduction, flexion, and horizontal abduction. Based on our clinical experience, a goniometer was used to measure the ROM for all subjects.\u003c/p\u003e\u003cp\u003eThe Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a widely used standardized assessment tool for upper limb function. It is a patient-reported outcome measure that includes a core set of 30 questions, 23 of which assess upper limb function and 7 assess symptoms, including pain (at rest, during activity, and at night), strength, and stiffness.\u003c/p\u003e\u003cp\u003eThe DASH score is calculated by summing the scores of the 30 items and then applying the following formula: DASH score = (Total sum of the 30 items − 30 [minimum score]) / 1.20. This transformation scales the raw score to a range of 0 to 100, where 0 indicates normal upper limb function and 100 indicates severe impairment.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eContinuous variables were analyzed using the Mann-Whitney U test and are reported as medians with their respective minimum and maximum ranges. Categorical variables were compared using Fisher's exact test. All statistical analyses were performed using SPSS software. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003ePatient characteristics\u003c/h2\u003e\n \u003cp\u003eA retrospective analysis was conducted on the medical records of 136 patients who underwent ALND at our center from January 2022 to October 2024. After applying the inclusion and exclusion criteria, 70 patients from the conventional surgery group were excluded, resulting in the inclusion of 56 patients. Of these, 29 underwent E-ALND, and 27 underwent R-ALND (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The demographic and clinical characteristics of the patients are summarized in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. There was no statistically significant difference in age between the two groups (R-ALND group: 55.83\u0026thinsp;\u0026plusmn;\u0026thinsp;14.89 vs. E-ALND group: 49.81\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4, P\u0026thinsp;=\u0026thinsp;0.084). No statistically significant differences were observed between the two groups in terms of pathological staging, hormone receptor status, HER2 status, Ki-67 expression, histological grading, preoperative chemotherapy, or type of breast surgery.\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinicopathologic characteristics of E-ALND and R-ALND\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eE-ALND (n\u0026thinsp;=\u0026thinsp;29)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eR-ALND (n\u0026thinsp;=\u0026thinsp;27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e \u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (Y)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.83\u0026thinsp;\u0026plusmn;\u0026thinsp;14.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.81\u0026thinsp;\u0026plusmn;\u0026thinsp;10.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathologic stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (51.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (38.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstrogen receptor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (68.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (70.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eProgesterone receptor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (44.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (55.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (59.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHER2 status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (68.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (62.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eKi-67\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (72.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistological grade\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.892\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (79.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (74.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (18.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative chemotherapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (65.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.398\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (44.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (51.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (55.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (48.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eAbbreviations: E-ALND,endoscopic axillary lymph node dissection; R-ALND,robotic axillary lymph node dissection\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison of surgical outcomes\u003c/h2\u003e\n \u003cp\u003eThe mean operative time for the E-ALND group was significantly longer compared to the R-ALND group (60.10\u0026thinsp;\u0026plusmn;\u0026thinsp;19.37 min vs. 43.37\u0026thinsp;\u0026plusmn;\u0026thinsp;12.40 min, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, the R-ALND group had a significantly lower mean blood loss (3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40 ml vs. 9.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29 ml, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). During the postoperative recovery period, the total axillary drainage volume was 247.66\u0026thinsp;\u0026plusmn;\u0026thinsp;198.42 ml for the E-ALND group and 192.48\u0026thinsp;\u0026plusmn;\u0026thinsp;139.06 ml for the R-ALND group, with no statistically significant difference between the groups (p\u0026thinsp;=\u0026thinsp;0.237). Although the postoperative axillary drain retention time was similar for both the E-ALND group (8.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.65 days) and the R-ALND group (7.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51 days, p\u0026thinsp;=\u0026thinsp;0.485), the R-ALND group had a significantly shorter postoperative hospital stay (9.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38 days vs. 10.69\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20 days, p\u0026thinsp;=\u0026thinsp;0.033). Furthermore, there were no statistically significant differences between the two groups in the mean number of axillary lymph nodes dissected or the number of positive nodes (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSurgical outcomes of E-ALND and R-ALND\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eE-ALND (n\u0026thinsp;=\u0026thinsp;29)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eR-ALND (n\u0026thinsp;=\u0026thinsp;27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e \u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime for ALND (minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.10\u0026thinsp;\u0026plusmn;\u0026thinsp;19.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.37\u0026thinsp;\u0026plusmn;\u0026thinsp;12.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood loss (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDrainage flow (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e247.66\u0026thinsp;\u0026plusmn;\u0026thinsp;198.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e192.48\u0026thinsp;\u0026plusmn;\u0026thinsp;139.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of axillary drainage (d)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePost-operation hospital stay (d)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.69\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of lymph nodes harvested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.88\u0026thinsp;\u0026plusmn;\u0026thinsp;6.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of metastatic lymph nodes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.14\u0026thinsp;\u0026plusmn;\u0026thinsp;7.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;4.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo pain (PS\u0026thinsp;=\u0026thinsp;0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (63.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMild pain (PS\u0026thinsp;=\u0026thinsp;1\u0026ndash;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (72.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (37.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate to severe pain (PS\u0026thinsp;\u0026ge;\u0026thinsp;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eAbbreviations: E-ALND,endoscopic axillary lymph node dissection; R-ALND,robotic axillary lymph node dissection;PS，Pain score\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePostoperative Clinical outcome of E-ALND and R-ALND\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eE-ALND (n\u0026thinsp;=\u0026thinsp;29)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eR-ALND (n\u0026thinsp;=\u0026thinsp;27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWound infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAxillary seroma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor wound healing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymphorrhagia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymphedema of the upper limbs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003eAbbreviations: E-ALND,endoscopic axillary lymph node dissection; R-ALND,robotic axillary lymph node dissection;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eArm Morbidities in the two Groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eE-ALND (n\u0026thinsp;=\u0026thinsp;29)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eR-ALND (n\u0026thinsp;=\u0026thinsp;27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e \u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eShoulder Abduction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e178.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e178.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 3 months after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e165.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e174.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eShoulder Flexion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e178.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e178.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.844\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 3 months after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e167.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173.04\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eShoulder Horizontal abduction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.97\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 3 months after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDASH score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 1 months after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt 3 months after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eArm Function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBurning sensation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eAbbreviations: DASH, Disabilities of the Arm, Shoulder, and Hand\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eComparison of postoperative complications\u003c/h3\u003e\n\u003cp\u003eNeither the E-ALND nor the R-ALND group experienced postoperative bleeding or wound infection. One case of axillary hematoma occurred in the endoscopic group, which was successfully treated with aspiration and pressure dressing. Additionally, there was one case of poor wound healing and two cases of lymphatic leakage in the endoscopic group. Persistent pressure dressing in the axillary area was found to improve lymphatic leakage. In contrast, the robotic group had no occurrences of hematoma, poor wound healing, or lymphatic leakage.\u003c/p\u003e\n\u003ch3\u003ePostoperative upper limb function\u003c/h3\u003e\n\u003cp\u003eBefore surgery, there was no statistically significant difference in shoulder abduction, shoulder flexion, and horizontal abduction ROM between the two groups. However, at the 3-month postoperative follow-up, the R-ALND group showed significantly greater ROM in shoulder abduction (174.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u0026deg; vs. 165.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u0026deg;, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and shoulder flexion (173.04\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u0026deg; vs. 167.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62\u0026deg;, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to the E-ALND group. Similarly, the horizontal abduction ROM also demonstrated a similar trend (33.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99\u0026deg; vs. 30.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.40\u0026deg;, p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003ePreoperatively, there was no significant difference in DASH scores between the two groups. However, at the 1-month postoperative follow-up, the R-ALND group had significantly lower DASH scores compared to the E-ALND group (10.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35 vs. 14.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At the 3-month postoperative follow-up, upper limb function improved in both groups, but the R-ALND group still had lower DASH scores than the E-ALND group (6.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86 vs. 9.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eAt the three-month postoperative follow-up, the E-ALND group reported a significantly higher incidence of reduced sensation (8 cases, 27.6%), burning sensation (6 cases, 20.7%), and numbness (8 cases, 27.6%) in the upper limb compared to the R-ALND group, which had only 1 case (3.7%) of reduced sensation and 1 case (3.7%) of numbness, with no cases of burning sensation. The differences between the two groups were statistically significant. However, there was no significant difference in postoperative upper limb pain between the two groups (3 cases, 10.3% in the E-ALND group vs. 0 cases, 0% in the R-ALND group, p\u0026thinsp;=\u0026thinsp;0.132). These results suggest that the R-ALND group had a lesser impact on postoperative upper limb sensation and function, allowing for greater activity in the affected upper limb.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe conducted a single-center retrospective case study to report the safety and efficacy of robotic surgery for axillary lymph node dissection compared to endoscopic axillary lymph node dissection.\u003c/p\u003e \u003cp\u003eEndoscopic surgery has been widely applied in the treatment of breast cancer; however, its efficacy and safety remain a subject of debate. In an epidemiological study, the mortality rate for minimally invasive surgery in patients with stage IA2 or IB1 cervical cancer was significantly higher than that for open surgery (P\u0026thinsp;=\u0026thinsp;0.002) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A meta-analysis showed that patients undergoing minimally invasive radical hysterectomy had a 71% higher risk of recurrence and a 56% higher risk of death [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. During endoscopic surgery, surgical instruments enter the axilla in a nearly vertical direction, with limited angles for horizontal manipulation, and the narrow space can easily lead to instrument interference. Additionally, endoscopic surgery requires an experienced assistant physician, which many medical centers lack. Overall, these factors affect the quality of endoscopic surgery. Although current studies have demonstrated the safety of E-ALND for breast cancer, there is still a lack of large-scale and prospective studies.\u003c/p\u003e \u003cp\u003eRobotic surgery can overcome the limitations of endoscopic surgery. In fact, robotic instruments have multiple degrees of freedom, offering flexibility similar to a surgeon's hand, with even better stability. The magnified three-dimensional vision provides a more detailed surgical field, controlled by the surgeon, which can replace the role of an assistant in endoscopic surgery. These technical advantages make robotic surgery more accurate and convenient for axillary lymph node dissection. However, there are currently few studies reported on robotic axillary lymph node dissection, and no studies comparing endoscopic and robotic axillary lymph node dissection. In our study, robotic axillary lymph node dissection significantly reduced intraoperative bleeding, postoperative pain, and hospital stay duration. Additionally, robotic surgery had a lesser impact on postoperative upper limb function and sensation, allowing for greater activity in the affected upper limb.\u003c/p\u003e \u003cp\u003eReduced intraoperative bleeding can decrease surgical time and accelerate postoperative recovery. In our study, the R-ALND group had significantly shorter surgical times (43.37\u0026thinsp;\u0026plusmn;\u0026thinsp;12.40 min vs. 60.10\u0026thinsp;\u0026plusmn;\u0026thinsp;19.37 min, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, the mean blood loss in the R-ALND group was significantly lower (3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40 ml vs. 9.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29 ml, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Compared to endoscopic surgery, the da Vinci robotic system offers a larger magnification of up to 10\u0026ndash;15 times, providing a clearer and more detailed surgical field, which allows for the early identification of small vessels within the axillary field, thereby reducing intraoperative bleeding and enhancing the quality and safety of the surgery. The robotic surgery system can also reduce the shaking of the surgical field compared to the assistance provided by endoscopic surgery, offering a more stable surgical view. Surgeons can achieve higher precision and reduce intraoperative bleeding through a clearer and more stable surgical field provided by the robotic surgery system. The reduction in intraoperative bleeding results in a clearer surgical field, avoiding surgical errors caused by field contamination and reducing surgical complications. Similar observations can be made in studies comparing robotic and open axillary dissection, where robotic surgery can significantly reduce intraoperative bleeding [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDuring ALND, there is a risk of damaging the intercostobrachial nerve, which can lead to postoperative upper limb functional and sensory impairments. These impairments are challenging to treat and can cause psychological barriers, thereby affecting the patient's quality of life. The intercostobrachial nerve originates from the anterior branch of the second intercostal nerve and innervates the skin of the axillary region and lateral chest wall, controlling upper limb sensory functions. Its unique anatomical position, traversing the fatty tissue of the axillary region in a \"natural space\" between the anterior and posterior axillary wall fascia, makes it difficult to dissect intact, often resulting in intraoperative damage. Our study found that at the three-month postoperative upper limb sensory assessment, the robotic group had significantly fewer cases of upper limb sensory reduction (1 case, 3.7%), burning sensation (0 cases, 0%), and numbness (1 case, 3.7%) compared to the endoscopic group. This suggests that robotic surgery may offer better preservation of the intercostobrachial nerve, leading to fewer postoperative sensory impairments.\u003c/p\u003e \u003cp\u003eCompared to endoscopic surgery, robotic surgery offers a more stable operation due to the absence of tremors in the robotic instruments, allowing surgeons to dissect the intercostobrachial nerve with greater precision and protection. In prostate cancer lymph node dissection, the deep location and narrow space of the male pelvis highlight the advantages of robotic surgery. Studies comparing robotic and endoscopic surgery have shown that robotic surgery better preserves pelvic nerves, significantly reducing the incidence of postoperative urinary retention [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Furthermore, robotic surgery systems feature instruments with 7 degrees of freedom and the ability to rotate 540\u0026deg;, due to their unique internal joint design. This makes robotic surgery more efficient than endoscopic surgery, as it can navigate around the intercostobrachial nerve to perform more delicate axillary dissections. Although the intercostobrachial nerve does not directly control upper limb joint movements, research indicates that preserving this nerve significantly reduces the risk of postoperative sensory abnormalities and neuropathic pain, facilitating upper limb functional recovery. Our study results also demonstrate that at one and three months postoperatively, patients in the robotic group had significantly better upper limb function compared to the endoscopic group (10.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35 vs. 14.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.49, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 6.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86 vs. 9.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This underscores the potential benefits of robotic surgery in enhancing postoperative outcomes.\u003c/p\u003e \u003cp\u003eThis study has certain limitations. Firstly, it is a single-center retrospective study with a small sample size. Secondly, due to the short follow-up period, this study only discusses the short-term efficacy and safety of robotic surgery, without conducting a long-term assessment of oncological safety. Moving forward, we will continue to follow up with patients and include a larger cohort to confirm the reliability of our findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCompared with E-ALND, R-ALND can significantly reduce intraoperative bleeding, have less impact on postoperative upper limb function and sensation, and have greater upper limb motion on the affected side.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflicts of interest\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflicts of interest in this study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eStudy concept and design: Z.W. and H.L.; analysis and interpretation data: Z.W. , Z.C.,Z.L, X.F.,L.W.,and H.L.; drafting of the manuscript: Z.W. and H.L.; revision of the manuscript: Z.W. , Z.C.,Q.L.,Z.H.,and H.L..; approval the manuscript: all authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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Int J Med Robot 17(6):e2307 [PMID: 34270843. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/rcs.2307]\u003c/span\u003e\u003cspan address=\"10.1002/rcs.2307]\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenon M, Tewari A, Baize B, Guillonneau B, Vallancien G (2002) Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 60(5):864\u0026ndash;868 [PMID: 12429317 DOI: 10.1016/s0090-4295(02)01881-2]\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Robotic Surgery, Endoscopic Surgery, Axillary Lymph Node Dissection, Breast Cancer, Minimally Invasive Techniques","lastPublishedDoi":"10.21203/rs.3.rs-5787958/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5787958/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRobotic surgery for breast cancer is increasingly being adopted, but the evidence on its effectiveness and safety remains limited. This study aimed to compare the surgical quality and short-term outcomes of robotic and endoscopic axillary lymph node dissection in patients with node-positive breast cancer. Here we report the short-term outcomes of this trial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis single-center retrospective study compared the short-term efficacy and safety of endoscopic (E-ALND) and robotic (R-ALND) axillary lymph node dissection in patients with node-positive breast cancer. Patients were recruited from those who underwent surgery at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2022 and October 2024. Clinical and pathological characteristics, surgical outcomes, and postoperative complications were analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 56 patients, with 29 undergoing E-ALND and 27 undergoing R-ALND. The R-ALND group had significantly shorter surgical times (43.37 ± 12.40 min vs. 60.10 ± 19.37 min, p \u0026lt; 0.001) and lower mean blood loss (3.26 ± 2.40 ml vs. 9.24 ± 4.29 ml, p \u0026lt; 0.001). Postoperatively, the R-ALND group had better upper limb function and sensation, with significantly lower DASH scores at 1-month (10.87 ± 1.35 vs. 14.64 ± 3.49, p \u0026lt; 0.001) and 3-month (6.68 ± 1.86 vs. 9.24 ± 2.74, p \u0026lt; 0.001) follow-ups. The R-ALND group also had fewer postoperative complications, including a lower incidence of reduced sensation, burning sensation, and numbness in the upper limb.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared with E-ALND, R-ALND significantly reduces intraoperative bleeding and postoperative complications, resulting in better upper limb function and sensation. These findings suggest that R-ALND may offer superior clinical outcomes for patients undergoing axillary lymph node dissection for breast cancer.\u003c/p\u003e","manuscriptTitle":"Efficacy and safety of endoscopic versus robotic axillary lymph node dissection in patients with node-positive breast cancer: a comparative retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-13 17:36:37","doi":"10.21203/rs.3.rs-5787958/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4a47d76d-71f2-460b-bab3-42a1456ce15b","owner":[],"postedDate":"January 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-14T20:53:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-13 17:36:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5787958","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5787958","identity":"rs-5787958","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}