{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:50:13Z","timestamp":1787021413759,"version":"build-2736575974"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endoscopic nipple-sparing mastectomy (NSM) offers excellent cosmetic outcomes but remains technically demanding with conventional straight laparoscopic instruments, particularly in the medial, inferior, and retroareolar regions. The HandX\u2122 (HumanTouch Surgical Ltd, Israel) is a 5-mm handheld, software-driven motorized articulating system that provides wrist-like motion. Its application in endoscopic breast surgery has not been previously reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>\n                      We present the first clinical use of this articulating system in single-port endoscopic NSM with immediate implant-based reconstruction. Two patients\u2014one therapeutic case following complete clinical response to neoadjuvant chemotherapy and one bilateral prophylactic case\u2014underwent NSM through a lateral incision using a standard single-port system. The articulating monopolar scissors were used to complete the superior, medial, inferior, and retroareolar dissection under CO\n                      <jats:sub>2<\/jats:sub>\n                      insufflation. Reconstruction was performed with prepectoral placement of an anatomical implant wrapped in an acellular dermal matrix (Braxon\u00ae FAST, Decomed Srl, Italy).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All procedures were completed successfully without intraoperative complications. Operative times were 240 min for the unilateral case, including axillary procedure, and 250 min for the bilateral case. Blood loss was minimal, and both patients were discharged within 48 h. Drains were removed on postoperative day 7. No early (30-day) or late (90-day) complications occurred. Final pathology demonstrated a pathologic complete response in the therapeutic case and multifocal atypical ductal hyperplasia in the prophylactic case.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Single-port endoscopic NSM using a software-driven motorized articulating system is technically feasible and facilitates dissection in challenging regions. This technique represents a minimally invasive approach positioned between fully robotic systems and endoscopic techniques, and warrants further evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-19442-2","type":"journal-article","created":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T17:31:25Z","timestamp":1773509485000},"page":"5606-5607","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Single-Port Endoscopic Nipple-Sparing Mastectomy Using a Handheld Motorized Articulating System: Technical Description and Initial Outcomes"],"prefix":"10.1245","volume":"33","author":[{"given":"Vasileios","family":"Kalles","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolos","family":"Mitrousias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolos","family":"Vlachogiorgos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra Maria","family":"Tsoti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loukas","family":"Kaklamanis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michail","family":"Gkiaourakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Toesca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Papapanagiotou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,14]]},"reference":[{"key":"19442_CR1","doi-asserted-by":"publisher","first-page":"784","DOI":"10.21037\/gs.2019.11.02","volume":"8","author":"CW Mok","year":"2019","unstructured":"Mok CW, Lai HW. Evolution of minimal access breast surgery. Gland Surg. 2019;8:784\u201393. https:\/\/doi.org\/10.21037\/gs.2019.11.02.","journal-title":"Gland Surg."},{"key":"19442_CR2","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1001\/jamasurg.2024.2865","volume":"159","author":"JH Kim","year":"2024","unstructured":"Kim JH, Ryu JM, Bae SJ, et al. Minimal access vs conventional nipple-sparing mastectomy. JAMA Surg. 2024;159:1177\u201386. https:\/\/doi.org\/10.1001\/jamasurg.2024.2865.","journal-title":"JAMA Surg."},{"key":"19442_CR3","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2024.08.010","author":"S Elghazaly","year":"2025","unstructured":"Elghazaly S, Fakeh S, Elbarbary S, et al. Robot-assisted versus open surgery in early-stage breast cancer: a systematic review and meta-analysis. Clin Breast Cancer. 2025. https:\/\/doi.org\/10.1016\/j.clbc.2024.08.010.","journal-title":"Clin Breast Cancer."},{"key":"19442_CR4","doi-asserted-by":"publisher","first-page":"e28","DOI":"10.1097\/SLA.0000000000002213","volume":"266","author":"A Toesca","year":"2017","unstructured":"Toesca A, Peradze N, Galimberti V, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with implant: first report of surgical technique. Ann Surg. 2017;266:e28\u201330. https:\/\/doi.org\/10.1097\/SLA.0000000000002213.","journal-title":"Ann Surg."},{"key":"19442_CR5","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1007\/s11701-024-02394-2","volume":"19","author":"M Maes-Carballo","year":"2025","unstructured":"Maes-Carballo M, G\u00f3mez-Fandi\u00f1o Y, Bra\u00f1a PMS, et al. Robotic nipple-sparing mastectomy: a comparative analysis with conventional and endoscopic techniques through a systematic review. J Robot Surg. 2025;19:220. https:\/\/doi.org\/10.1007\/s11701-024-02394-2.","journal-title":"J Robot Surg."},{"key":"19442_CR6","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1089\/lap.2023.0188","volume":"34","author":"R Mao","year":"2024","unstructured":"Mao R, Gao L, Wu G, et al. Literature review of handheld articulating instruments in minimally invasive surgery. J Laparoendosc Adv Surg Tech A. 2024;34:47\u201354. https:\/\/doi.org\/10.1089\/lap.2023.0188.","journal-title":"J Laparoendosc Adv Surg Tech A."},{"key":"19442_CR7","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s11701-024-02503-1","volume":"19","author":"N Messer","year":"2025","unstructured":"Messer N, Ben Yehuda A, Manoskin Y, et al. Performance and operative outcomes evaluation of a hand-held articulating laparoscopic device: a prospective clinical trial on the HandX platform. J Robot Surg. 2025;19:401\u20138. https:\/\/doi.org\/10.1007\/s11701-024-02503-1.","journal-title":"J Robot Surg."}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-19442-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-026-19442-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-19442-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T18:28:42Z","timestamp":1778869722000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-026-19442-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,14]]},"references-count":7,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["19442"],"URL":"https:\/\/doi.org\/10.1245\/s10434-026-19442-2","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,14]]},"assertion":[{"value":"9 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no conflicts of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}