Endoscopic DIEP flap dissection (eDIEP): An experimental cadaveric study

Stroumza, N.; Barthélémy, R; Majoulet, Laurene; Delchet, Ophelie; Qassemyar, Q.; Atlan, Michaël

doi:10.1016/j.bjps.2017.05.021

Cited by 12 publications

(11 citation statements)

References 6 publications

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“…1 Patients and surgeons alike now seek ways to harvest abdominal free flaps based on fewer perforators through smaller fascial incisions to mitigate risks associated with increased myofascial dissection and consequent injury and denervation of the abdominal wall. [2][3][4][5][6][7][8][9][10][11] Existing literature suggests 1/10 patients undergoing free flap breast reconstruction with muscle-sparing or myofascial-sparing techniques that may develop significant abdominal wall donor site morbidity in the form of eventration or hernia. 12 Building upon existing literature related to laparoendoscopic single-site surgery, we believe a significant contributor to DIEP flap donor site morbidity is the need for a fascial incision(s) large enough for light and instruments to permit safe and reliable pedicle dissection.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopy allows the harvest of the DIEP flap with shorter fascial incisions as compared to endoscopic harvest: A single surgeon retrospective cohort study

Shakir

Spencer

Piper

et al. 2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Section: Introductionmentioning

confidence: 99%

Laparoscopy allows the harvest of the DIEP flap with shorter fascial incisions as compared to endoscopic harvest: A single surgeon retrospective cohort study

Shakir

Spencer

Piper

et al. 2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…[6][7][8][9][10] In recent years, attention has been cast toward the harvest of the DIEP flap for breast reconstruction using these minimally invasive approaches. [11][12][13][14][15] In general, two robotic-assisted approaches have been described for DIEP flap harvest: transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). The former involves entering the intra-abdominal space, incising the peritoneum adjacent to it for dissection and opening the posterior rectus sheath (PRS) to identify the deep inferior epigastric vascular pedicle; the latter comprises entering and creating the preperitoneal space without violating the PRS and/or peritoneum and dissecting the vascular pedicle.…”

mentioning

confidence: 99%

Robotic-Assisted DIEP Flap Harvest for Autologous Breast Reconstruction: A Comparative Feasibility Study on a Cadaveric Model

Manrique

Bustos

Mohan

et al. 2020

J Reconstr Microsurg

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Background The deep inferior epigastric perforator (DIEP) flap is the most common perforator flap for microsurgical breast reconstruction. Contrary to the conventional open approach, robotic-assisted DIEP flap harvest intends to preserve ARS integrity, thereby reducing the morbidity. We assessed the feasibility and compared performance outcomes of a robotic, cadaveric training model for DIEP flap harvest using two approaches: transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). Methods A robotics system (da Vinci Xi) was applied in conjunction with a cadaveric training model. Ports were placed in the abdominal wall to triangulate each DIEP flap. Surgical time and technical characteristics were recorded. Values were analyzed and compared. Results Eight female cadavers (16 hemi-DIEP flaps) were dissected: 50% TAPP and 50% TEP approaches. Mean harvest time was 56 minutes (range: 48–74 minutes) and 65 minutes (range: 60–83 minutes) for TAPP versus TEP groups, respectively (p < 0.05). Mean pedicle dissection time was 36 minutes (range: 25–40 minutes) and 39 minutes (range: 30–42 minutes) for TAPP versus TEP groups, respectively (p > 0.05). Intra-abdominal contents were manipulated twice on average in the TAPP group versus 0 times in the TEP group (p < 0.05). One TAPP case had an injury to the bowel, and one TEP case was converted to conventional open due to pneumoperitoneum. Conclusion Robotic-assisted DIEP flap harvest represents a technological enhancement for advanced regenerative plastic surgery. Our model demonstrated both TAPP and TEP are feasible, with TEP less invasive, preserving the posterior rectus sheath, and decreasing complication risks. However, there is a steeper and longer learning curve for TEP.

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“…Other techniques have been described for minimally invasive DIEP flap harvest using laparoscopic-assistance 12 and endoscopic assistance. 3 Additionally, robotic or laparoscopic-assisted DIEP harvest could be performed by total extraperitoneal approach rather than by our preferred transabdominal pre-peritoneal (TAPP) approach. 9 , 13 , 14 Our rationale for performing a minimally invasive DIEP using the TAPP approach has been previously described.…”

Section: Discussionmentioning

confidence: 99%

Robotic DIEP Patient Selection: Analysis of CT Angiography

Kurlander

Le-Petross

Shuck

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Preoperative CTA is widely used and extensively studied for planning of DIEP flap breast reconstruction. However, its utility in planning robotic DIEP harvest is undescribed. Methods: The authors conducted a retrospective study of consecutive patients presenting to the clinics of select plastic surgeons between 2017 and 2021 for abdominally based autologous breast reconstruction. CTA measurements of intramuscular perforator distance and perforator-to-external iliac distance were used as predicted robotic and open fascial incision lengths, respectively. It was documented if the predicted robotic incision would avoid crossing the arcuate line. Operative notes were reviewed for fascial incision length and number of perforators harvested. Predicted and actual robotic fascial incision lengths were compared. Results: CTAs were reviewed for 49 patients (98 hemiabdomens). Inadequate or no perforators were identified on CTA in 18% of hemiabdomens. Mean predicted robotic and open DIEP fascial incisions were 3.1 cm and 12.2 cm, respectively, giving robotic approach fascial incision benefit of 9.1 cm ( P < 0.001). The predicted robotic incision avoided crossing the arcuate line in 71% of hemiabdomens. Thirteen patients (28%) underwent robotic DIEP harvest. Actual robotic fascial incision length averaged 3.5 cm, which was not significantly different from the mean predicted fascial incision length ( P = 0.374). Robotic DIEP flaps had fewer perforators (1.8 versus 2.6, P = 0.058). Conclusion: CTA is useful for identifying patients with anatomy favorable for robotic DIEP flap harvest.

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Endoscopic DIEP flap dissection (eDIEP): An experimental cadaveric study

Cited by 12 publications

References 6 publications

Laparoscopy allows the harvest of the DIEP flap with shorter fascial incisions as compared to endoscopic harvest: A single surgeon retrospective cohort study

Laparoscopy allows the harvest of the DIEP flap with shorter fascial incisions as compared to endoscopic harvest: A single surgeon retrospective cohort study

Robotic-Assisted DIEP Flap Harvest for Autologous Breast Reconstruction: A Comparative Feasibility Study on a Cadaveric Model

Robotic DIEP Patient Selection: Analysis of CT Angiography

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