This study aims to learn whether a handheld robotic device, called the HandX, can help surgeons safely perform a minimally invasive nipple-sparing mastectomy. This type of mastectomy uses a small incision at the side of the breast to remove breast tissue while keeping the skin and nipple in place. The goal is to lower scarring, improve comfort, and support good cosmetic results after surgery.
Participants in this study will already be planning to have a therapeutic or preventive mastectomy with immediate implant-based reconstruction. All surgeries are done at Mediterraneo Hospital in Greece.
During the operation, surgeons use the HandX device to assist with the endoscopic dissection. Researchers will collect information about how long the surgery takes, whether the planned approach can be completed without switching to open surgery, and whether any surgical complications occur. They will also check healing, infection, and implant-related problems for up to 365 days after surgery. Participants will complete the BREAST-Q questionnaire before surgery and at several times after surgery to share their views on comfort, well-being, and cosmetic outcomes.
About 15 participants will take part. The results will help researchers understand whether this approach is practical and safe, and whether it should be studied further in a larger trial.
Female sex
Age ≥ 18 years old
early invasive breast cancer (Clinical Stage I-II at diagnosis) undergoing primary surgery
early invasive breast cancer (Clinical Stage I-II at diagnosis) undergoing surgery post systemic (neoadjuvant) therapy with clinical evidence of partial or complete response
Chest wall or skin invasion
Extended lymph node involvement at diagnosis (cN2)
Inflammatory breast cancer
Tumor distance from nipple - areola complex <1cm on imaging studies
Single group
Endoscopic nipple sparing mastectomy
Procedure/SurgeryA minimally invasive nipple-sparing mastectomy performed through a single lateral mammary fold incision using endoscopic visualization and CO₂ insufflation. Breast tissue is dissected from the skin envelope and nipple-areola complex, and immediate implant-based reconstruction is performed according to standard practice. The HandX device is used for articulating endoscopic dissection.
HandX endoscopic instrument
DeviceA handheld articulating endoscopic instrument used to assist with endoscopic dissection during nipple-sparing mastectomy. The HandX device provides wrist-like articulation, motion scaling, and ergonomic control during minimally invasive surgery.
Technical success
Completion of the planned procedure via the minimally invasive approach without unplanned conversion.
Surgical Safety
Major (Clavien-Dindo ≥III) complications
Operative Time
Total Operative Time
Blood Loss
Intraoperative Blood Loss
Length of Stay
Length of hospital stay in days
Complications
30-day complication rate (Clavien-Dindo)
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Vasileios Kalles
Lead sponsor
Mediterraneo Hospital
Sponsor institution
