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“…The robotic approach presents several potential advantages over laparoscopy for VOLT flap harvest, including three‐dimensional visualization, tremor elimination, and superior instrument articulation. 33 , 34 A study of a small cohort of patients whom underwent robotic VOLT flap harvest found that the surgeon was able to dissect the lymphatics and vasculature with greater precision, although the operative times were longer. 35 Recently, authors successfully performed robotic VOLT for lymphedema using a single‐port robotic platform.…”
Background: Vascularized omental lymphatic transplant (VOLT) is an increasingly popular treatment of extremity lymphedema given its promising donor site. While the success of VOLT in the treatment of lymphedema has been reported previously, several questions remain.Aim: To further elucidate appropriate use of VOLT in the treatment of lymphedema, specifically addressing patient selection, harvest technique, and operative methods.Methods and Results: A systematic review of VOLT for upper extremity lymphedema was performed. Of 115 yield studies, seven were included for analysis based on inclusion and exclusion criteria. Included studies demonstrated significant reductions in extremity circumference/volume (average volume reduction, 22.7%-39.5%) as well as subjective improvements using patient-reported outcomes. Though studies are heterogenous and limited, when analyzed in aggregate, suggest the efficacy of VOLT in lymphedema treatment.
Conclusion:This is the largest systematic review of VOLT to date. VOLT continues to show promise as a safe and efficacious surgical intervention for lymphedema in the upper extremity. Further studies are warranted to more definitively identify patients for whom this technique is appropriate as well as ideal harvest and inset technique.
“…The robotic approach presents several potential advantages over laparoscopy for VOLT flap harvest, including three‐dimensional visualization, tremor elimination, and superior instrument articulation. 33 , 34 A study of a small cohort of patients whom underwent robotic VOLT flap harvest found that the surgeon was able to dissect the lymphatics and vasculature with greater precision, although the operative times were longer. 35 Recently, authors successfully performed robotic VOLT for lymphedema using a single‐port robotic platform.…”
Background: Vascularized omental lymphatic transplant (VOLT) is an increasingly popular treatment of extremity lymphedema given its promising donor site. While the success of VOLT in the treatment of lymphedema has been reported previously, several questions remain.Aim: To further elucidate appropriate use of VOLT in the treatment of lymphedema, specifically addressing patient selection, harvest technique, and operative methods.Methods and Results: A systematic review of VOLT for upper extremity lymphedema was performed. Of 115 yield studies, seven were included for analysis based on inclusion and exclusion criteria. Included studies demonstrated significant reductions in extremity circumference/volume (average volume reduction, 22.7%-39.5%) as well as subjective improvements using patient-reported outcomes. Though studies are heterogenous and limited, when analyzed in aggregate, suggest the efficacy of VOLT in lymphedema treatment.
Conclusion:This is the largest systematic review of VOLT to date. VOLT continues to show promise as a safe and efficacious surgical intervention for lymphedema in the upper extremity. Further studies are warranted to more definitively identify patients for whom this technique is appropriate as well as ideal harvest and inset technique.
“…What is more, the risk of damaging adjacent anatomical structures is minimized due to the tremor amortization and increased motion of freedom. The inclusion of additional imaging tools, such as fluorescent optics to visualize the blood and lymphatic vascular patterns, allows for improving the flap design and harvest [20,21] .…”
Section: Robotic-assisted Harvest Of Vascularized Lymphatic Tissuementioning
The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures, which are applied in lymphatic reconstructive surgery to restore lymphatic vascular integrity and treat lymphedema. Procedures such as the establishment of lymphovenous anastomosis (LVA), the harvest of lymph nodes from anatomic locations that reduce donor-side morbidity and the transplantation of the vascularized lymph node flaps (VLNT) present procedures necessitating extreme precision and dexterity in often difficult-to-reach areas, thus pushing the physical limitations of the performing microsurgeon. Despite being limited in number, recent preclinical and clinical studies of independent groups using different robotic systems demonstrate the feasibility of robotic technology to perform supermicrosurgical procedures successfully. The robotic assistance offers unparalleled precision, refining the surgical techniques and minimizing potential side effects, with clinical outcomes comparable to the conventional techniques. Although the relative disadvantages of robotic assistance mostly appear to be related to adequate training and the prolonged learning curve, the technology promises to revolutionize the field of supermicrosurgery and improve the clinical outcomes of lymphatic reconstructive surgery.
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