Robotic‐assisted deep inferior epigastric artery perforator flap abdominal harvest for breast reconstruction: A case report

Gundlapalli, Vinay S; Ogunleye, Adeyemi A.; Scott, Kiandra; Wenzinger, Eric; Ulm, Jason P.; Tavana, Lance; Pullatt, Rana; Delaney, Kevin O

doi:10.1002/micr.30297

Cited by 54 publications

(71 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Both medial and lateral row perforators may be utilized via the same approach described above. Similar favorable anatomic characteristics have been noted in prior studies, with a type 1 or extramuscular DIEP vascular pattern described as ideal (Gundlapalli et al, 2018;Ogunleye et al, 2018;Selber, 2020). While in theory an intramuscular perforator dissection could be performed with robotic assistance, the fascial incision length will not significantly shorten.…”

Section: Resultssupporting

confidence: 83%

“…In this technique, the deep inferior epigastric vessels are harvested via three port incisions and pulled through a small fascial incision after the abdominal tissue is raised and perforators identified in typical fashion (Pedersen et al, 2014; Selber, 2020). Use of the surgical robot in DIEP flap reconstruction was first reported in 2018, and since then only a few cadaveric studies and a single technical description have been published to date (Gundlapalli et al, 2018; Manrique et al, 2020; Selber, 2020; Struk et al, 2018). There remains debate as to patient indications, order of operative steps, and anatomic limitations of robotic DIEP harvest (Benjoar et al, 2018; Ogunleye et al, 2018) .In this report, we offer our evolving technique for robotic DIEP flap harvest, adding to the paucity of literature while also describing our outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Robotic deep inferior epigastric perforator flap harvest in breast reconstruction

et al. 2022

View full text Add to dashboard Cite

Introduction Reducing donor site morbidity after deep inferior epigastric artery perforator (DIEP) flap harvest relies mainly upon maintaining integrity of the anterior rectus sheath fascia. The purpose of this study is to describe our minimally‐invasive technique for robotic DIEP flap harvest. Methods A retrospective review of four patients undergoing seven robotic‐assisted DIEP flaps from 2019 to 2020 was conducted. Average patient age and BMI were 52 years (range: 45–60 years) and 26.7 kg/m2 (range: 20.6–32.4 kg/m2), respectively. Average follow‐up was 6.31 months (range: 5.73–7.27 months). Robotic flap harvest was performed with intramuscular perforator dissection in standard fashion, followed by the transabdominal preperitoneal (TAPP) approach to DIEP pedicle harvest using the da Vinci Xi robot. Data was collected on demographic information, perioperative characteristics. Primary outcomes included successful flap harvest as well as donor site morbidity (e.g., abdominal bulge, hernia, bowel obstruction, etc.). Results All four patients underwent bilateral abdominally‐based free flap reconstruction. Three patients received bilateral robotic DIEP flaps, and one patient underwent unilateral robotic DIEP flap reconstruction. The da Vinci Xi robot was used in all cases. Average flap weight and pedicle length were 522 g (range: 110–809 g) and 11.2 cm (range: 10–12 cm), respectively. There were no flap failures, and no patient experienced abdominal wall donor site morbidity on physical exam. Conclusion While further studies are needed to validate its use, this report represents the largest series of robotic DIEP flap harvests to date and is a valuable addition to the literature.

show abstract

Section: Resultssupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Robotic deep inferior epigastric perforator flap harvest in breast reconstruction

et al. 2022

View full text Add to dashboard Cite

show abstract

“…[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

View full text Add to dashboard Cite

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.

show abstract

“…Scar reduction is imperative, not only in flap insetting, but also in flap harvesting, and is feasible with robots (36,37). Using robots to harvest radial forearm free flaps can provide superior postoperative outcome in terms of both aesthetics and complications (Figure 1).…”

Section: Microvascular Reconstruction Using Free Flapsmentioning

confidence: 99%

Robot-assisted surgeries in oral and maxillofacial area: a narrative review on the present, advantages and its future

Kim¹,

Cho²,

Kim³

2022

Front Oral Maxillofac Med

View full text Add to dashboard Cite

To survey the advantages, future prospects, and cases using robotic systems in oromaxillofacial surgery.Background: With the accumulation of advances in minimally invasive surgery in the entire body area, robot-assisted surgeries have become very common in operating rooms, despite of their short history. Thus, advances in robotic surgery are accelerating rapidly, particularly with respect to the maxillofacial region. In this regard, researchers reviewed the literatures using the keywords given below, including systematic metaanalysis.Methods: The report follows the format of the "narrative review" and reviewed literatures extracted from the PubMed database since 1980 when 'Robotic surgical procedures', 'neck dissection' and 'oral surgery' were searched.Conclusions: Robotic surgery in the oral and maxillofacial region allows the incision to hide the scar by making the incision line far from the surgical field, resulting in fewer intra-operative and post-operative complications, such as amount of drainage or hospital days. Furthermore, recent studies show similar or superior results in terms of oncologic safety of robot assisted surgeries compared to conventional surgeries.Robotic surgery is likely to extend throughout the oral and maxillofacial region once it becomes capable of manipulating bone such as in osteotomies, particularly as robotic systems become smaller. When combined with artificial intelligence technology, the surgical robot will become more useful and powerful in relieving human suffering.

show abstract

Robotic‐assisted deep inferior epigastric artery perforator flap abdominal harvest for breast reconstruction: A case report

Cited by 54 publications

References 15 publications

Robotic deep inferior epigastric perforator flap harvest in breast reconstruction

Robotic deep inferior epigastric perforator flap harvest in breast reconstruction

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

Robot-assisted surgeries in oral and maxillofacial area: a narrative review on the present, advantages and its future

Contact Info

Product

Resources

About