Robotic-Assisted Omentum Flap Harvest: A Novel, Minimally Invasive Approach for Vascularized Lymph Node Transfer
Jordan D. Frey, M.D., Jason W. Yu, D.M.D., M.D., Lee C. Zhao, M.D., Steven M. Cohen, D.O., Mihye Choi, M.D., Jamie P. Levine, M.D..
NYU Langone Health, New York, NY, USA.
Background: The omentum provides abundant lymphatic tissue with reliable vascular anatomy, representing an ideal donor for vascularized lymph node transfer without risk for donor site lymphedema. We describe a novel, robotic-assisted approach for omental flap harvest.
Methods: All patients undergoing robotic-assisted omentum harvest for vascularized lymph node transfer from 2017 to 2019 were identified. Patient demographics, intra-operative variables, and post-operative outcomes were reviewed.
Results: Five patients underwent robotic-assisted omentum flap harvest for vascularized lymph node transfer. Average patient age and body-mass index were 51.2 years and 29.80 kg/m2. Indications for lymph node transfer were upper extremity lymphedema following mastectomy, radiation, and lymphadenectomy (60.0%), congenital unilateral lower extremity lymphedema (20.0%), and bilateral lower extremity/scrotal lymphedema following partial penectomy and bilateral inguinal/pelvic lymphadenectomy (20.0%). Four patients (80.0%) underwent standard robotic harvest while one patient underwent single-port robotic harvest. Average number of port sites was 4.4. One patient required a 5-centimeter upper midline laparotomy incision to retrieve the omentum. All patients underwent omentum flap transfer to two sites; in two cases, the flap was conjoined and in three cases, the flap was segmented. In all upper extremity cases, anastomoses were performed in the axilla to the thoracodorsal vessels and in the upper arm to the radial recurrent vessels. In one lower extremity, one flap was transferred to the descending genicular vessels in the medial thigh while one was transferred end-to-end to the posterior tibial vessels at the ankle. In the other lower extremity case, a conjoined omentum flap was transferred to the bilateral groins and perineum with one pedicle anastomosed to the deep inferior epigastric vessels and a second vein anastomosed contralaterally. Three patients (60.0%) underwent concomitant scar release while two patients (40.0%) each underwent lipectomy and skin grafting. Average overall operative time was 9:19. Average inpatient hospitalization was 5.2 days. Two patients experienced cellulitis that resolved with oral antibiotics. There were no major complications. All patients reported subjective improvement in swelling and softness of the affected extremity. Average follow-up was 8.8 months.
Conclusions: Robotic-assisted omental harvest for vascularized lymph node transfer is a novel, safe, and viable minimally-invasive approach offering improved intra-abdominal visibility and maneuverability for flap dissection.
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