Summary:
Vascularized tissue for obliteration of large pelvic dead spaces created by extirpative surgery has been shown to reduce complication rates. As more extensive resections are performed robotically, plastic surgeons have been challenged to reconstruct the resulting defects using a minimally invasive approach. The goal of this study was to report the authors’ experience with robotic harvest of the rectus abdominis muscle for reconstruction of pelvic defects. The authors conducted a retrospective case series of patients who underwent robotic flap harvest following robotic extirpative surgery at their institution. Patient demographics, surgical characteristics, and postoperative outcomes were collected. These were compared to a retrospective cohort of patients who underwent open rectus abdominis muscle harvest. The authors identified seven male patients who underwent robotic flap harvest for pelvic reconstruction between 2013 and 2019. Their mean age was 66 ± 6 years and mean body mass index was 31 ± 5 kg/m2. Six patients (86 percent) had a history of radiation therapy and five patients (71 percent) received hormone therapy or chemotherapy. Surgical-site complications occurred in two patients. One patient developed ventral hernia. The donor-site complication rate was 19 percent (n = 18) in patients who underwent open rectus abdominis muscle harvest (n = 95). This study demonstrates the safety, efficacy, and reproducibility of robotic harvest of the rectus abdominis muscle in complex, multidisciplinary, minimally invasive pelvic surgery. The technique avoids violation of the anterior rectus sheath and wound complications related to open flap harvest, and early experience suggests reduced donor-site morbidity.
CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
METHODS: 26,152 patients were identified as having underwent radical or partial nephrectomy in New York State between 2008 and 2015 using the Statewide Planning and Research Cooperative (SPARCS) database. Patients and hospitals were assigned to 8 health service areas. Patients were determined as traveling if they underwent surgery at a different health service area. RESULTS: From 2008 to 2016, the proportion of robotic procedure increased for both PN (18.5% to 58.1%, p<.0001) and RN (3.7% to 23%, p<.0001), while utilization of open and laparoscopic approaches has decreased (p<.0001). Similarly, the number of hospital performing RPN (22 to 57, p¼0.0071) and RRN (18 to 49, p¼0.0012) increased. At the same time, the proportion of patients traveling for RPN (39.3% to 22%, p¼0.0002) and RRN (35.9% to 23.5%, p¼0.0176) decreased, while there were no significant changes for the open (OPN/ ORN) and laparoscopic (LPN/LRN) approaches (p>0.05 for all).CONCLUSIONS: The utilization of robotic assisted approaches for partial and radical nephrectomy has been increasing, resulting in the decline of open and laparoscopic approaches. Additionally, the regional dissemination of these robotic procedures is growing, evident by the increasing number of hospitals and decreasing proportion of patients traveling for these procedures.
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