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Robotic harvest of deep inferior epigastric artery perforator flaps: Lessons learned
Brian Chen MD, Elizabeth Bailey MD, William Nelson MD, Richard Fortunato, DO, Stanislav Nosik, MD, Daniel Murariu, MD, Andrea Moreira MD
Allegheny Health Network
2023-02-10
Presenter: Brian Chen
Affidavit:
This project is original work of the resident and his coauthors. Greater than 50% of this submission is attributable to the submitting resident with the remainder contributed by the coauthors.
Director Name: Alan Murdock
Author Category: Other Specialty Resident
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 discuss our experiences with refining a transabdominal approach to robotic DIEP flap harvest using the Da Vinci Xi robot.
Methods
We examined consecutive patients who underwent robotic DIEP flap harvest between 07/2021-09/2023. We looked at case length and complexity over time as evidenced by need for extra anastomoses or APEX procedure. We also compared robotic time between general and plastic surgeons as we became more adept at our technique.
Results
Twenty-five patients underwent robotic harvest over the study period. Robotic dissection time improved from over an hour to consistently 30 minutes or less per side with an average time of 38.7 and 36.3 minutes for the plastic and general surgeons, respectively (p = 0.7). Number of APEX procedures performed increased over this time as well.
Conclusion
As we refined and became more experienced with our robotic technique, we broadened our inclusion criteria and performed more complex dissections without compromising results. There is a learning curve involved for both plastic and general surgeons, though with practice the difference becomes negligible. This technique can be adopted by centers with robotic and microsurgical expertise; however, we recommend beginning with more straightforward cases until the learning curve is achieved.
