Transabdominal Robotic Harvest of Bilateral DIEP Pedicles in Breast Reconstruction: Technique and Interdisciplinary Approach.

IF 2.2 3区 医学 Q2 SURGERY
Daniel Murariu, Brian Chen, Elizabeth Bailey, William Nelson, Richard Fortunato, Stanislav Nosik, Andrea Moreira
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引用次数: 0

Abstract

Background:  The deep inferior epigastric artery perforator (DIEP) flap is the gold standard for autologous breast reconstruction. However, the conventional procedure's anterior sheath division, from perforating vessels to the pedicle origin, risks weakening the abdominal wall's primary strength layer. Employing the da Vinci Xi Surgical System with indocyanine green dye and near-infrared fluorescence imaging, we refined a robotic technique for bilateral DIEP flap harvest. This approach enhances safety during vessel dissection, utilizing smaller fascial incisions. This study will present this technique in detail to microsurgeons interested in robotic DIEP flaps.

Methods:  In a retrospective cohort study spanning July 2021 to September 2022, female patients undergoing robotic bilateral DIEP flap reconstruction were analyzed. Following suprafascial flap dissection, the surgical robot was docked to target the pelvis, identifying and exposing deep inferior epigastric vessels intracorporeally. Mobilization and division occurred at their bases, with retrieval through a minimal anterior fascial incision, minimizing disruption to the abdominal wall and its motor innervation.

Results:  The study comprised 23 patients (46 flaps), with a mean fascial length of 4.1 cm and mean pedicle length of 12.82 cm. Mesh usage was absent. Robotic time averaged 139 minutes, overall case length was 739 minutes, and the average length of stay was 3.9 days. Notably, no pedicle or intra-abdominal injuries were reported.

Conclusion:  This technique ensures safe and efficient pedicle dissection in robotic DIEP flap harvests. Given the limited number of plastic surgeons adept in minimally invasive abdominal surgeries, we recommend collaborative efforts, with general surgeons initially assisting microsurgeons in adopting the robotic approach. This strategy facilitates a smooth transition until plastic surgeons attain confidence and competence in independent robotic dissection.

经腹机器人采集双侧 DIEP椎弓根用于乳房重建:技术和跨学科方法。
背景:下腹深动脉穿孔(DIEP)皮瓣是自体乳房重建的黄金标准。然而,传统手术的前鞘分割(从穿孔血管到蒂起源)有可能削弱腹壁的主要强度层。利用达芬奇Xi手术系统和吲哚青绿染料及近红外荧光成像技术,我们改进了双侧DIEP皮瓣采集的机器人技术。这种方法利用较小的筋膜切口,提高了血管解剖时的安全性。本研究将向对机器人 DIEP 皮瓣感兴趣的显微外科医生详细介绍这项技术:在 2021 年 7 月至 2022 年 9 月的一项回顾性队列研究中,对接受机器人双侧 DIEP 皮瓣重建术的女性患者进行了分析。筋膜上皮瓣剥离后,手术机器人停靠在骨盆上,识别并在体腔内暴露下腹深血管。在其基部进行移动和分割,通过最小的前筋膜切口进行回收,最大限度地减少对腹壁及其运动神经支配的破坏:研究包括 23 名患者(46 个皮瓣),平均筋膜长度为 4.1 厘米,平均瓣蒂长度为 12.82 厘米。没有使用网片。机器人手术时间平均为 139 分钟,整个病例时间为 739 分钟,平均住院时间为 3.9 天。值得注意的是,未报告有椎弓根或腹腔内损伤:结论:这项技术确保了机器人 DIEP 皮瓣采集中安全高效的茎突解剖。鉴于擅长腹部微创手术的整形外科医生人数有限,我们建议开展合作,由普外科医生首先协助显微外科医生采用机器人方法。这种策略有利于平稳过渡,直到整形外科医生在独立机器人解剖方面获得信心和能力。
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来源期刊
CiteScore
4.50
自引率
28.60%
发文量
80
审稿时长
1 months
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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