Expanding the Horizon: Single-port Robotic Vascularized Omentum Lymphatic Transplant

Abstract

Summary: Vascularized omentum lymphatic transplant is frequently used for the treatment of lymphedema due to demonstrated efficacy, a reduced complication profile, and, in particular, negligible risk of donor site lymphedema. Historically harvested by open laparotomy, more recent techniques involve laparoscopic omental harvest. Although effective and reproducible, laparoscopy may be limited by reduced visualization, minimal tactile feedback, multiple port sites, and imprecise instrumentation. Therefore, we employed the da Vinci Single-Port (SP) surgical robot system for vascularized omentum lymphatic transplant. A 52-year-old man with a 3-year history of progressive left lower extremity swelling and lymphoscintigraphy and magnetic resonance lymphangiogram consistent with lymphedema of unknown etiology underwent vascularized omentum lymphatic transplant to the left groin. A 2.5-cm infraumbilical incision was used for placement of the primary trocar, through which the camera and operating instruments were passed. Following robotic harvest, the omental lymph node flap was transferred to the left groin for microsurgical anastomosis. The procedure was uneventful, and the patient was discharged on postoperative day 1. At 6 weeks, there were no complications. Here, we show for the first time the safety and feasibility of robotic omental lymph node flap harvest for extremity lymphedema using the da Vinci Single-Port robotic system. The benefits of this technology include a minimally-invasive approach that allows for flap dissection and removal through a single 2.5-cm incision. Further investigation is necessary to characterize the indications and limitations of this technique in plastic surgery.

Vascularized omental lymphatic transplant for upper extremity lymphedema: A systematic review

“…This further reduced donor site morbidity and limited the number of incisions necessary for omental harvest. 36 Early results justify further investigation into the application of robotic surgery for omental flap harvest. This findings of this review seem to corroborate previous studies and systematic reviews of surgical lymphedema treatment.…”

“…This further reduced donor site morbidity and limited the number of incisions necessary for omental harvest. 36 Early results justify further investigation into the application of robotic surgery for omental flap harvest.…”

Does plastic surgery need a rewiring? A survey and systematic review on robotic-assisted surgery

“…Sixteen studies had less than 10 total patients and were excluded from formal analysis (Supplemental Table 1). 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24

Figure 5 PRISMA diagram.

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Robotics in Microsurgery and Supermicrosurgery

“…The da Vinci SP has been utilized for harvesting a vascularized omental flap in the treatment of a 52-year-old-man with a 3-year history of progressive lower extremity lymphedema. 37 Teven et al were able to robotically harvest and extract the omental flap through a single 2.5-cm incision using the da Vinci SP system. 37 The robotic-assisted harvest included right gastroepiploic pedicle dissection and lymphatic vessel identification and flap incorporation.…”