Establishing a standardized robotic approach for technetium-99 m-defined sentinel lymph node dissection with indocyanine green-guided navigation in da Vinci Xi & SP system.

Sentinel lymph node dissection (SLND) remains pivotal in axillary staging for early breast cancer. Although robotic platforms enhance surgical precision, standardized robotic protocols integrating technetium-99 m (Tc-99 m)-defined sentinel lymph nodes (SLNs) identification with indocyanine green (ICG)-guided robotic dissection remain undeveloped. This study aimed to establish and evaluate a standardized robotic-assisted SLND approach combining Tc-99 m SLN identification with ICG-guided dissection using the da Vinci Xi & SP system. This single-center retrospective study included 57 patients who underwent robotic-assisted nipple-sparing mastectomy with concomitant SLND between June 2024 and August 2025. ICG was administered via subcutaneous injection at the lateral nipple-areolar complex, followed by a standardized uptake interval of 20–30 min. Tc-99 m isotope mapping was performed preoperatively for SLN identification, followed by ICG-guided robotic localization using Firefly fluorescence imaging. Intraoperative gamma-probe confirmation verified Tc-99 m uptake, and only Tc-99 m-avid nodes were excised. The median age was 51 years, and most patients had early-stage disease (stage 0–II, 93.0%) and luminal subtypes (79.0%). The mean interval from ICG injection to dissection was 31.9 ± 8.1 min. The median operative time for SLND was 20.0 min, with a median of 3 nodes retrieved per patient. Drainage output decreased to < 10 mL within 72 h, although drains were removed at the first outpatient visit (median, 5 days). No intraoperative adverse events were documented. The standardized robotic-assisted SLND protocol integrating Tc-99 m-defined SLN identification with ICG-guided robotic dissection is feasible and reproducible. Further prospective studies are warranted to evaluate postoperative morbidity and long-term oncologic outcomes.Trial registration number: Not applicable.