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Robotic versus standard harvest of bilateral deep inferior epigastric artery perforator flaps: Early outcomes
Elizabeth Bailey MD, Brian Chen MD, William Nelson MD, Stanislav Nosik, MD, Richard Fortunato, DO, Daniel Murariu, MD, Andrea Moreira MD
University of Pittsburgh
2022-01-15
Presenter: Elizabeth Bailey MD
Affidavit:
Vu Nguyen MD
Director Name: Vu Nguyen MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Traditional harvest of the deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction splits the anterior sheath of the rectus fascia from the perforating vessels to the deep inferior epigastric artery origin, weakening the primary strength layer of the abdominal wall. Minimally invasive techniques are being developed to decrease abdominal wall morbidity. We refined a transabdominal approach to robotic bilateral DIEP flap harvest using the Da Vinci Xi robot. This study examines outcomes of this approach and compares robotic (rDIEP) to standard (sDIEP) harvest.
Methods
A retrospective cohort study was performed for bilateral rDIEP or sDIEP flap harvest between 07/2021-12/2021. Outcomes included abdominal wall morbidity, dissection time, total OR time, and length of stay (LOS).
Results
Nineteen patients were included (11 sDIEP (22 flaps), 8 rDIEP (16 flaps)) with no difference in patient age, BMI, or abdominal surgical history between cohorts. Mean fascial incision length in the rDIEP group was 4.8cm (mean pedicle length 12.5cm), sparing an average of 8.4cm. Mesh reinforcement was used in 0/8 rDIEP patients vs 9/11 sDIEP patients (p<0.001). Average robotic time was 175 minutes in the rDIEP group, without significant increase in overall case length (765 min vs 679 min, p=0.129). LOS was shorter with rDIEP (3.6 days vs 4.9 days, p=0.005).
Conclusion
This is the largest cohort of rDIEP flaps and first to compare outcomes to sDIEP. rDIEP is associated with decreased fascial incision length, elimination of the need for abdominal wall reinforcement and a reduction in LOS.
