Endoscopic and Da Vinci robotic-assisted surgery in breast cancer: a narrative review of current evidence, technical advances, and future perspectives.

BACKGROUND AND OBJECTIVE: Minimally invasive surgery (MIS) has been increasingly adopted in breast cancer management. Endoscopic breast surgery (EBS) and Da Vinci robotic-assisted breast surgery have emerged as the two principal MIS modalities, with the potential to combine adequate oncological safety with improved aesthetic outcomes. This review summarises the technical evolution, surgical and oncological outcomes, and learning curves of EBS and Da Vinci robotic-assisted breast surgery, and discusses cost considerations and future perspectives. METHODS: We performed a structured search on PubMed, Web of Science, Scopus, and the Cochrane Library from database inception to 31 March 2026, with a supplementary literature update conducted to include relevant studies published through 1 May 2026. We included studies comparing endoscopic or robotic-assisted techniques with conventional approaches for breast-conserving surgery (BCS), nipple-sparing mastectomy (NSM), axillary lymph-node dissection (ALND), and breast reconstruction. Randomised controlled trials, prospective and retrospective cohort studies, case series, systematic reviews, and meta-analyses were eligible. KEY CONTENT AND FINDINGS: EBS, first developed in East Asian centres, can provide superior cosmetic outcomes in patients with early-stage breast cancer compared with conventional open surgery while maintaining acceptable short-term oncological results. Robotic-assisted NSM (RNSM) with the Da Vinci system provides three-dimensional high-definition visualisation, articulated EndoWrist instruments, and tremor filtering. Pooled data indicate that RNSM is associated with lower rates of skin-flap and nipple-areola complex (NAC) necrosis than conventional open NSM, with comparable short-term oncological outcomes; operative time and procedural costs remain higher. The learning curve for RNSM stabilises after approximately 20-50 cases. The latest development is the Da Vinci single-port (SP) system, which achieves a true single-incision mastectomy via a concealed axillary approach. CONCLUSIONS: Endoscopic and Da Vinci robotic-assisted surgery may be considered as minimally-invasive treatments for breast cancer surgery. Available data suggest short- to medium-term oncological equivalence with conventional surgery and favourable patient-reported outcomes, but long-term follow-up beyond 5 years remains scarce. Prospective randomised controlled trials with prolonged follow-up, formal cost-effectiveness analyses, and standardised training programmes are required before these techniques can be recommended for routine clinical use.