Pardolesi A, Ferrari M, Leuzzi G, Stanzi A, Calderoni M, Uslenghi C, Scarci M, Raveglia F, Cioffi U, Solli P. Robotic approach for lymphadenectomy of internal mammary lymph nodes in breast cancer: Five case reports. World J Clin Oncol 2025; 16(10): 108876 [DOI: 10.5306/wjco.v16.i10.108876]
Corresponding Author of This Article
Michele Ferrari, Department of Thoracic Surgery, Istituto Nazionale Tumori, Via Venezian 1, Milan 20133, Lombardy, Italy. michele.ferrari@istitutotumori.mi.it
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Surgery
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 24, 2025 (publication date) through Oct 27, 2025
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World Journal of Clinical Oncology
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2218-4333
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Pardolesi A, Ferrari M, Leuzzi G, Stanzi A, Calderoni M, Uslenghi C, Scarci M, Raveglia F, Cioffi U, Solli P. Robotic approach for lymphadenectomy of internal mammary lymph nodes in breast cancer: Five case reports. World J Clin Oncol 2025; 16(10): 108876 [DOI: 10.5306/wjco.v16.i10.108876]
World J Clin Oncol. Oct 24, 2025; 16(10): 108876 Published online Oct 24, 2025. doi: 10.5306/wjco.v16.i10.108876
Robotic approach for lymphadenectomy of internal mammary lymph nodes in breast cancer: Five case reports
Alessandro Pardolesi, Michele Ferrari, Giovanni Leuzzi, Alessia Stanzi, Matteo Calderoni, Clarissa Uslenghi, Marco Scarci, Federico Raveglia, Ugo Cioffi, Piergiorgio Solli
Alessandro Pardolesi, Michele Ferrari, Giovanni Leuzzi, Alessia Stanzi, Matteo Calderoni, Clarissa Uslenghi, Piergiorgio Solli, Department of Thoracic Surgery, Istituto Nazionale Tumori, Milan 20133, Lombardy, Italy
Marco Scarci, Department of Thoracic Surgery, University College London Hospitals, London W2 1NY, United Kingdom
Federico Raveglia, Department of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Lombardy, Italy
Ugo Cioffi, Department of Surgery, University of Milan, Milan 20122, Lombardy, Italy
Co-corresponding authors: Michele Ferrari and Ugo Cioffi.
Author contributions: Pardolesi A, Leuzzi G, and Stanzi A contributed to the conception and design of the study; Ferrari M and Cioffi U contributed to preparing and submitting the manuscript and all required supplementary files, managing all correspondence with the editorial, ensuring that all authors reviewed and approved the final manuscript version, coordinating responses to post-publication inquiries, and managing any data-sharing requests, they contributed equally to this manuscript and are co-corresponding authors; Calderoni M and Uslenghi C were responsible for data collection and curation. Scarci M and Raveglia F contributed to manuscript drafting; Solli P performed data analysis and interpretation, supervised the overall project, and critically revised the manuscript for intellectual content. All authors reviewed the final version, and approved it for submission.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michele Ferrari, Department of Thoracic Surgery, Istituto Nazionale Tumori, Via Venezian 1, Milan 20133, Lombardy, Italy. michele.ferrari@istitutotumori.mi.it
Received: April 25, 2025 Revised: May 30, 2025 Accepted: September 2, 2025 Published online: October 24, 2025 Processing time: 182 Days and 11.2 Hours
Abstract
BACKGROUND
Internal mammary (IM) lymphadenopathies in breast cancer indicate a worse prognosis than axillary metastases, yet they are rarely assessed. Accurate staging is essential for treatment planning. Robotic biopsy offers a promising alternative to video-assisted thoracic surgery for precise histological sampling. This article outlines a systematic robot-assisted dissection approach to enhance staging accuracy and optimize breast cancer management.
CASE SUMMARY
At our institution, robotic lymphadenectomy of the IM chain was performed in 5 patients between July 2020 and December 2024. Patients were positioned in a 30° semi-supine position with a roll under the shoulder to elevate the chest. The camera port was inserted in the fifth intercostal space along the mid-axillary line, allowing a 0°, 12 mm robotic camera to inspect the chest cavity; CO2 insufflation (8 L/minute, 8-10 mmHg) facilitated lung collapse and pneumo-mediastinum formation for improved dissection. Under direct vision, two additional operative ports were placed: One in the third intercostal space (anterior axillary line) and another in the fifth intercostal space (3-4 cm lateral to the parasternal line). The mean operative time was 118 minutes, with a median hospital stay of two days. No major complications occurred. Histology confirmed breast carcinoma metastases in three patients, while two had benign disease.
CONCLUSION
Robotic biopsy of IM lymph nodes is safe, feasible, and provides key information on breast cancer management, with very rare contraindications
Core Tip: Robotic-assisted surgery for internal mammary lymph node dissection is a highly effective, minimally invasive technique that overcomes the limitations of video-assisted thoracic surgery. It offers superior three-dimensional visualization, greater instrument maneuverability, and improved ergonomics for the surgeon. The panoramic view improves staging and specimen biopsy, while meticulous dissection prevents vascular injury. Proper incision placement is crucial in patients with breast implants. One-lung ventilation may limit eligibility, and high body mass index may increase complexity.
