The Usefulness of Endoscopic Harvesting of the Latissimus Dorsi Flap for Breast Reconstruction Using a Single-Port and CO2 Gas Insufflation Technique

Kim, Do Gon; Kim, Jong Seong; Lee, Joon Seok; Lee, Jeeyeon; Park, Ho Yong; Yang, Jung Dug

doi:10.1007/s00266-021-02467-1

Cited by 5 publications

(32 citation statements)

References 23 publications

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“…However, the traditional process of harvesting the LDMF results in a dorsal scar of 20–45 cm, which many patients find unacceptable ( 2 , 3 ). To minimize scarring, the endoscopic technique (ET) and robotic technique (RT) have been developed, but neither technique has been widely adopted ( 4 ). The ET has limitations in terms of negotiating the convex contour of the posterior chest wall and difficulty maintaining an optical window, which leads to operational difficulty, insufficient LDMF volume, and a prolonged operation time ( 3 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery

Wen¹,

Xie²,

Feng³

et al. 2022

Gland Surg

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Background: A novel endoscopic-assisted technique (NET) was created by our team for nipple-sparing mastectomy (NSM) and latissimus dorsi muscle flap (LDMF) reconstruction that enables the procedure to be conducted through a single axillary incision. The authors hypothesized that the NET has the advantages of the traditional ET (TET) and a reduced operation time. The purpose of this study is to compare the advantages and disadvantages of NET, TET and open surgery. Methods: A retrospective cohort study was performed on patients who underwent LDMF reconstruction after NSM using open surgery, the TET, or the NET between January 2013 and June 2021. The following outcomes were compared: the operation time, size of the LDMF, the complication rate, hospital length of stay, hospital costs, aesthetic results (the BREAST-Q questionnaire), and quality of life (QoL). The BREAST-Q questionnaire and QoL were underwent preoperatively and 1, 3, and 12 months postoperatively. Results: A total of 17 ETs (comprising 10 NETs and 7 TETs) and 28 open surgery procedures were identified and analyzed, the baseline characteristics were comparable in terms of age, BMI, tumor location, cup size, and disease stage of the three groups. The mean operation time of the NET group (395.8±176.0 min) in the exploration stage was shorter than that of the TET group (531.6±69.6 min) and equivalent to that of the open surgery group (400.9±67.3 min). The overall postoperative complication rates of the ET and open surgery groups were 35.3% and 60.7%, respectively (P=0.09). The aesthetic results in relation to patients' satisfaction with their breasts (P=0.001) and backs (P=0.001) were better in the ET group than the open surgery group beginning at 1 month postoperatively. The ET group had better psychosocial well-being beginning at 1 month postoperatively (P=0.002) and sexual well-being beginning at 3 months postoperatively (P<0.001) than the open surgery group.Conclusions: LDMF reconstruction after NSM using the ET is associated with lower complication rates, good aesthetic results, and a better QoL than open surgery procedures. The NET is a promising approach, a more convenient procedure, and has a shorter surgery time than TET, however, this conclusion needs to be further validated by RCT research with a larger sample size.

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Section: Introductionmentioning

confidence: 99%

Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery

Wen¹,

Xie²,

Feng³

et al. 2022

Gland Surg

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“…The total surgical time was 201.05 min in patients with Poland syndrome, 25,28 222.18 min for patients who had total mastectomy, 11,22,26,37 and 226 min who had a partial mastectomy (Figure 2). 2,19,20,34 The average LDF harvest time was 84.04 min (range, 25–240) (Figure 3) (Data ) 2,4,11,17,20,23,25,26,36,37 . When compared to the OT, Chang et al.…”

Section: Resultsmentioning

confidence: 99%

“…The longer surgical time and convexity of the thorax with constraints to maintain the surgical field are the critical drawbacks of EALDF versus an OT, even with insufflation 4,45 . In fact, 30 cases have been reported to be necessary to reach the plateau of the learning curve 11,12 .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies used insufflation 4,7,11,23,27,28,30–32,34,37,39 . In this review it was challenging to evaluate complications like subcutaneous emphysema, air embolism, hypothermia, and acid‐base imbalance.…”

Section: Discussionmentioning

confidence: 99%

“…One of its limitations when harvested for breast reconstruction using an open technique (OT) is the considerable residual donor‐site scar 2,3 . Aiming to minimise donor‐site morbidity, endoscopic‐assisted LDF (EALDF) has been implemented in recent years 4 . However, several centres have raised concerns regarding the 2‐dimensional surgical field and constraints inherent to operating over a thoracic convexity 4 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Minimally invasive harvest of the latissimus dorsi flap for breast reconstruction: A systematic review

Escandón

Nazerali

Ciudad³

et al. 2022

Robotics Computer Surgery

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Background Poor cosmetic results with oncoplastic and implant‐based breast reconstruction have stimulated an interest in latissimus dorsi flap (LDF)‐based reconstruction. We reviewed the surgical techniques and outcomes of the LDF harvested with minimally invasive surgery. Methods A systematic search was conducted across PubMed‐MEDLINE, Web of Science, Scopus, and Ovid‐MEDLINE(R). Data on surgical outcomes were extracted. Results 31 articles were included reporting on 857 reconstructive procedures using a LDF harvested, 497 were endoscopic‐assisted LDF (EALDF) (58%) and 174 were robotic‐assisted LDF (RALDF) (20.3%). The average flap harvest time was 84.04‐min for EALDF and 106.14‐min for RALDF. With an EALDF, the incidence of haematoma, seroma, and wound dehiscence ranged between 0%–16.6%, 0%–48%, and 0%–6.2%, respectively. Using RALDF, the incidence of seroma was between 0%–26.1% and 0%–3.4% for haematoma. Conclusions While the indications for a LDF harvested with MIS are limited, its main advantage for breast reconstruction is the absence of the back scar.

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Robot-Assisted Latissimus Dorsi Flap Harvest for Partial Breast Reconstruction: Comparison With Endoscopic and Conventional Approaches

Eo,

Kim,

Lee

et al. 2023

Aesthetic Surgery Journal

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Background Latissimus dorsi muscle flaps are widely used in breast reconstruction, for which several methods have been introduced. Objectives To compare the outcomes of robotic-assisted breast reconstruction using latissimus dorsi muscle flap following partial mastectomy with the outcomes of conventional and endoscopic-assisted techniques. Methods In this prospective single-institutional study, Korean females diagnosed with breast cancer who underwent partial mastectomy and breast reconstruction using a latissimus dorsi flap from March 2020 to December 2021 were included. The outcomes of surgery, as well as patient satisfaction, were compared between the conventional, endoscopic-assisted, and robotic-assisted techniques. Results In total, 57 patients were included in this study, among which 20 underwent conventional reconstruction, and 17 and 20 patients underwent endoscopic and robotic surgery, respectively. There was no statistically significant difference between the three methods in respect of postoperative opioid analgesic dosage (p = 0.459), hospitalization period (p = 0.225), and the average total amount of donor site drainage during hospitalization (p = 0.175). In respect of patient satisfaction after surgery, especially the donor site scar, the conventional method showed a significantly lower score compared with the other 2 techniques. Conclusions Robotic-assisted breast reconstruction using a latissimus dorsi muscle flap after partial mastectomy showed higher patient satisfaction than that in the conventional open method. Considering that robotic surgery is more convenient than the endoscopic technique, it is potentially a good alternative to conventional open or endoscopic surgery.

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The Usefulness of Endoscopic Harvesting of the Latissimus Dorsi Flap for Breast Reconstruction Using a Single-Port and CO2 Gas Insufflation Technique

Cited by 5 publications

References 23 publications

Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery

Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery

Minimally invasive harvest of the latissimus dorsi flap for breast reconstruction: A systematic review

Robot-Assisted Latissimus Dorsi Flap Harvest for Partial Breast Reconstruction: Comparison With Endoscopic and Conventional Approaches

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