CTA in preoperative planning for DIEP breast reconstruction: what the reconstructive surgeon wants to know. A modified Delphi study

Wong, K.K.; Stubbs, Euan; McRae, Mark

doi:10.1016/j.crad.2019.07.016

Clinical Radiology

2019

DOI: 10.1016/j.crad.2019.07.016

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CTA in preoperative planning for DIEP breast reconstruction: what the reconstructive surgeon wants to know. A modified Delphi study

K.K. Wong

Euan Stubbs

Mark McRae

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Cited by 4 publications

(3 citation statements)

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“…9 Even with favorable perforator selection by means of computed tomographic angiography, the risk of abdominal bulging could not be entirely resolved. [10][11][12][13] The introduction of the robot-assisted (RA) approach opened a new era. So far, few studies have been published, Summary: To minimize donor-site damage, robot-assisted (RA) deep inferior epigastric perforator (DIEP) flap harvest has been suggested.…”

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confidence: 99%

“…9 Even with favorable perforator selection by means of computed tomographic angiography, the risk of abdominal bulging could not be entirely resolved. 10–13 The introduction of the robot-assisted (RA) approach opened a new era. So far, few studies have been published, including cadaveric studies, 14,15 early technical reports/case reports/summaries, 16–19 and small series including three patients, 20 and 10 patients.…”

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confidence: 99%

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Novel Port Placement in Robot-Assisted DIEP Flap Harvest Improves Visibility and Bilateral DIEP Access: Early Controlled Cohort Study

Tsai

Kim

Kuo

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Summary: To minimize donor-site damage, robot-assisted (RA) deep inferior epigastric perforator (DIEP) flap harvest has been suggested. Current robotic approaches favor port placement, which either does not allow a bilateral DIEP flap harvest through the same ports or necessitates additional scars. In this article, the authors propose a modification of port configuration. In a retrospective controlled cohort study, RA-DIEP and conventional DIEP surgery were compared. The perforator and pedicle were visualized conventionally until the level behind the rectus abdominis muscle. Next, the robotic system was installed to dissect the retromuscular pedicle. The authors assessed patient age; body mass index; history of smoking, diabetes mellitus, and hypertension; and additional surgical time. The length of the anterior rectus sheath (ARS) incision was measured. Pain was quantified using the visual analogue scale. Donor-site complications were assessed. Thirteen RA-DIEP flaps (11 unilateral and two bilateral) and 87 conventional DIEP flaps were harvested without flap loss. The bilateral DIEP flaps were raised without readjustments of the ports. The mean time for pedicle dissection was 53.2 ± 13.4 minutes. The length of the ARS incision was significantly shorter in the RA-DIEP group (2.67 ± 1.13 cm versus 8.14 ± 1.69 cm; 304.87% difference; P < 0.0001). There was no statistical difference in postoperative pain (day 1: 1.9 ± 0.9 versus 2.9 ± 1.6, P = 0.094; day 2: 1.8 ± 1.2 versus 2.3 ± 1.5, P = 0.319; day 3: 1.6 ± 0.9 versus 2.0 ± 1.3, P = 0.444). Preliminary results show that the authors’ RA-DIEP approach is safe and allows dissection of bilateral RA-DIEP flaps with short ARS incision lengths. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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confidence: 99%

mentioning

confidence: 99%

Novel Port Placement in Robot-Assisted DIEP Flap Harvest Improves Visibility and Bilateral DIEP Access: Early Controlled Cohort Study

Tsai

Kim

Kuo

et al. 2023

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

“…Trainees then viewed eight abdominal perforator CTA scans to map perforators for pre-operative planning of a DIEP flap. For each hemi-abdomen, trainees used perforator size, location, relation to the umbilicus, and length of intramuscular course to identify the total number of perforators likely to be useful in reconstruction, as well as the dominant perforator (Wong et al, 2019).…”

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confidence: 99%

Utilizing augmented reality for Deep Inferior Epigastric Artery Perforator (DIEP) flap perforator selection

2023

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Pre-operative perforator mapping for Deep Inferior Epigastric Artery Perforator (DIEP) flap planning with two-dimensional (2D) computed tomography angiography (CTA) is common. However, 3D mapping of CTA images using augmented reality (AR) offers benefits including more intuitive interpretation of images and potential intraoperative application (Guha et al., 2017). In this letter, we present the findings of a preliminary study on examination of the feasibility of AR perforator mapping.

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Preoperative planning using virtual reality and computed tomography angiogram in deep inferior epigastric perforator flap breast reconstruction

Di Via Ioschpe,

Golijanin,

Benharush

et al. 2023

Journal of Plastic, Reconstructive & Aesthetic Surgery

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CTA in preoperative planning for DIEP breast reconstruction: what the reconstructive surgeon wants to know. A modified Delphi study

Cited by 4 publications

References 11 publications

Novel Port Placement in Robot-Assisted DIEP Flap Harvest Improves Visibility and Bilateral DIEP Access: Early Controlled Cohort Study

Novel Port Placement in Robot-Assisted DIEP Flap Harvest Improves Visibility and Bilateral DIEP Access: Early Controlled Cohort Study

Utilizing augmented reality for Deep Inferior Epigastric Artery Perforator (DIEP) flap perforator selection

Preoperative planning using virtual reality and computed tomography angiogram in deep inferior epigastric perforator flap breast reconstruction

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