Robotic-Assisted Deep Inferior Epigastric Perforator Harvest for Breast Reconstruction: A Consecutive Case Series
Susana Benitez Sanchez*1, Raquel Minasian2, Gainosuke Sugiyama1, Jesse Selber3, Mark Smith1, Emma Robinson4, Julia Silverman1, Neil Tanna1 1Northwell Health, Queens, NY; 2Keck Medicine of USC, Los Angeles, CA; 3MD Anderson, Houston, TX; 4Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
Plastic surgery has expanded to include the use of robotic surgery as a useful adjunct in breast reconstructive surgery. In a traditional deep inferior epigastric perforator (DIEP) flap harvest for breast reconstruction, a long fascial incision is required, which can lead to considerable donor site morbidity. With a robotic approach, the vascular pedicle can be dissected in the sub-muscular plane, through an intra-abdominal approach, thereby significantly reducing the length of the fascial incision. A shorter fascial dissection should decrease the rates of post-operative abdominal site morbidity and lead to improved patient outcomes.
All consecutive cases of robotic-assisted DIEP flaps for breast reconstruction from June 2022 to February 2023 within a single health care system (Northwell Health) were reviewed. Patient demographics, surgical characteristics, and complications were assessed.
A total of 17 female patients underwent robotic-assisted DIEP harvest. Mean patient age at time of surgery was 50.1 years and mean BMI was 26.4 kg/m2. Of 17 patients, 10/17 were bilateral and 2/17 were unilateral robotic-assisted DIEP flap breast reconstructions. The remaining 5/17 were bilateral DIEP flap reconstructions but vascular anatomy allowed for only one hemi-abdominal flap harvest to be performed with robotic assistance. A total of 8/17 were performed immediately at the time of mastectomy. All patients had preoperative magnetic resonance angiography (MRA). Mean length of fascial incision was 3.7 cm. Mean time on the robotic console was 75.1 minutes. Mean length of hospital stay was 2.2 days. All flaps were harvested with robotic assistance, without conversion to open technique. No abdominal donor site postoperative complications were noted, including abdominal wall bulge, hernia, necrosis, or delayed healing.
In appropriately selected candidates, robotic-assisted harvest of the deep inferior epigastric perforator flap is a safe, reliable, and reproducible technique to attempt at decreasing rates of abdominal donor site morbidity.
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