Clinical outcomes following robotic versus conventional DIEP flap in breast reconstruction: A retrospective matched study

Abstract

BackgroundA robotic deep inferior epigastric perforator (DIEP) flap created through a totally extraperitoneal approach minimizes violation of the donor site, which may lead to postoperative pain reduction and rapid recovery. The authors compared the clinical outcomes of robotic and conventional DIEP flap breast reconstructions.MethodsData from consecutive patients who underwent mastectomy with DIEP flaps for breast reconstruction between July 2017 and January 2021 were retrospectively reviewed. Patients were divided into robotic and conventional DIEP groups, and the two groups were matched using the inverse probability of treatment weighting method. They were compared based on the reconstruction time, drainage amount, postoperative pain, rescue analgesics, hospital stay, complications, and BREAST-Q scores.ResultsAfter matching, a dataset of 207 patients was formed, including 21 patients in the robotic DIEP group and 186 patients in the conventional DIEP group. The mean reconstruction time was longer in the robotic DIEP group than in the conventional DIEP group (P<0.001). In the robotic group, pain intensity during the postoperative 6–24 hours was significantly reduced (P=0.001) with less use of fentanyl (P=0.003) compared to the conventional DIEP group. The mean length of hospital stay for the robotic DIEP group was shorter than that for conventional DIEP (P=0.002). BREAST-Q scores indicated a higher level of the abdominal physical well-being domain in the robotic group (P=0.020). Complication rates were comparable between the two groups.ConclusionsThis study suggests that a robotic DIEP flap offers enhanced postoperative recovery, accompanied by a reduction in postoperative pain and hospital stay.

Robot‐assisted nipple‐sparing mastectomy and immediate breast reconstruction with gel implant and latissimus dorsi muscle flap: Our initial experience

“…[48][49][50][51] Furthermore, a robotic DIEP flap-based breast reconstruction could foster higher postoperative recovery accompanied by mitigation in postoperative pain and overall hospital stay. 52,53 Our study confirmed the efficacy of R-NSMIBR with gel implant and latissimus dorsi among the 15 patients as indicated by the absence of local recurrence or deaths. In addition, we have not observed any post-surgical complications including haematoma, seroma, infection, contracture of the envelope or necrosis of the nipple-areola.…”

Robotics in Implant-Based and Autologous Breast Reconstruction

“…Robotic employment in DIEP pedicle dissection increased the operative times by around 69 minutes on average, including the additional time required for robot setup and docking. 46…”

“…49 Additional studies describe similar findings, reporting fascial incisions measuring 1.5 to 4.3 cm. 9 10 46 49…”

“…49 Additional studies describe similar findings, reporting fascial incisions measuring 1.5 to 4.3 cm. 9,10,46,49 As more patients undergo robotic DIEP flap harvest, highpowered, long-term follow-up studies are needed to ascertain if robotic DIEP harvest results in reduced rates of postoperative abdominal hernias and bulging when compared to conventional techniques.…”

Robotic Plastic Surgery Education: Developing a Robotic Surgery Training Program Specific to Plastic Surgery Trainees

“…5,6 RAS DIEP flap harvest allows for long pedicle dissection (13-15 cm) with small fascial incisions (1-3 cm), which preserves abdominal wall integrity and lowers the risk of incisional bulging and herniation, which can be seen with abdominal based reconstruction. [6][7][8][9] LD flap harvest for breast reconstruction has historically required an incisional length anywhere from 15 to 45 cm for adequate exposure using conventional open techniques. 9,10 When harvested with robotic assistance, the LD flap incisional site is reduced to 4 or 5 cm-small enough to be hidden in a patient's axilla, which may be more favorable for the aesthetically conscious patient.…”