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Laparoscopic Assisted DIEP Flap Harvest Improves Breast Reconstruction Outcomes.
suhail kanchwala.
university of pennsylvania, merion, PA, USA.

Introduction: Total extra-peritoneal laparoscopic-assisted (TEP-lap-assisted) harvest of the deep inferior epigastric (DIE) vessels permits a dramatic decrease of myofascial dissection in DIEP flap breast reconstruction. We present a reliable technique that further decreases donor site morbidity in autologous breast reconstruction.
Methods: Patients who underwent TEP-lap-assisted harvest of the DIE vessels were reviewed from March to October 2018. A supraumbilical camera port was placed at the medial edge of the rectus muscle to enter the retrorectus space.  The extraperitoneal plane is developed using a balloon dissector and insufflation.  Two ports are then placed through the infraumbilical linea alba to dissect the DIE vessels in the retromuscular plane. Muscle branches and the superior epigastric vessels are ligated.  The DIE pedicle is ligated and the vessels delivered through a minimal fascial incision.
Results: Twenty-four subjects totaling 40 flaps were included in the study. All flaps were single perforator DIEP flaps.  The mean length of fascial incision was 1.9 cm.  Mean length of procedure for unilateral and bilateral reconstructions was 337.5 91.3 and 442.9 100.0 minutes, respectively, with patients in the latter half of the series undergoing significantly shorter harvest times. No subjects required narcotics during or after their hospitalization.  Mean length of stay was 2.1 days.  Successful flap salvage after venous congestion occurred in one subject. There was one pedicle transection during harvest that required perforator-to-pedicle anastomosis.
Conclusions: Total extra-peritoneal laparoscopic-assisted harvest of the DIE pedicle is a reliable method which dramatically decreases the pain and morbidity of autologous breast reconstruction.


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