A New Era in Perforator Flap Surgery for Breast Reconstruction: A Comparative Study of Robotic versus Standard Harvest of Bilateral Deep Inferior Epigastric Artery Perforator Flaps.
Andrea Moreira, Elizabeth A Bailey, Brian Chen, William Nelson, Jenna Li, Richard Fortunato, Stanislav Nosik, Daniel Murariu
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Abstract
Background: Traditional deep inferior epigastric artery perforator (DIEP) flap harvest splits the anterior sheath, weakening the abdominal wall and predisposing patients to bulge or hernia. Abdominal wall morbidity may be decreased using minimally invasive techniques. We refined a transabdominal approach to the robotic harvest of bilateral DIEP flaps.
Methods: A retrospective medical record study involving all patients who underwent bilateral or bipedicled robotic DIEP (rDIEP) or standard DIEP (sDIEP) flap harvest between July 2021 and September 2022. Outcomes included abdominal wall morbidity, total operative time, length of stay (LOS), and complications.
Results: Forty-seven patients were included (48 sDIEP flaps, 46 rDIEP flaps) with no significant difference in patient characteristics. Fascial incision length in the rDIEP group was shorter (4.1 vs. 11.7 cm, p < 0.001). Mesh reinforcement of the abdominal wall was used in 13/24 sDIEP and none in rDIEP patients (p < 0.001). Operative time was longer in the rDIEP cohort (739 vs. 630 minutes, p = 0.013), although subanalysis showed no difference in the second half of the cohort. The average robotic dissection time was 135 minutes, which decreased significantly with the surgeon's experience. There were no intraoperative complications from using the robot. LOS was shorter with rDIEP but not statistically significant (3.9 vs. 4.3 days, p = 0.157).
Conclusion: This study represents the most extensive cohort analysis of bilateral rDIEP flap harvest, offering a comprehensive comparison to traditional sDIEP. The initial results underscore the viability of robotic techniques for flap harvesting, highlighting potential advantages including reduced fascial incision length and decreased abdominal disruption. Furthermore, using robotics may obviate the necessity for fascial reinforcement with mesh.
背景：传统的下腹深动脉穿孔器（DIEP）皮瓣切除术会分割前鞘，削弱腹壁，使患者容易出现隆起或疝气。采用微创技术可降低腹壁的发病率。我们改进了一种经腹的双侧 DIEP 皮瓣机器人采集方法：回顾性病历研究，涉及2021年7月至2022年9月期间接受双侧或双足机器人DIEP（rDIEP）或标准DIEP（sDIEP）皮瓣采集的所有患者。结果包括腹壁发病率、总手术时间、住院时间（LOS）和并发症：结果：共纳入47例患者（48例sDIEP皮瓣，46例rDIEP皮瓣），患者特征无明显差异。rDIEP组的筋膜切口长度较短（4.1 cm vs. 11.7 cm，p p = 0.013），但子分析显示后半组患者的切口长度没有差异。机器人解剖的平均时间为135分钟，随着外科医生经验的增加而显著缩短。使用机器人没有术中并发症。使用rDIEP手术的住院时间更短，但无统计学意义（3.9天 vs. 4.3天，p = 0.157）：本研究对双侧rDIEP皮瓣采集进行了最广泛的队列分析，与传统的sDIEP进行了全面比较。初步结果强调了机器人技术用于皮瓣采集的可行性，突出了其潜在优势，包括减少筋膜切口长度和减少腹部破坏。此外，使用机器人技术还可避免使用网片进行筋膜加固。
期刊介绍：
The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers.
The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases.
The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.
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