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Expanding the Criteria for Robotic DIEP Case Report with Long Intramuscular Course
Diwakar Phuyal MBBS; Osama Darras MD; Raffi Gurunian MD, PhD; Risal Djohan MD; Graham Schwarz, MD, MSE, FACS; Clayton Petro, MD; Lucas Beffa, MD; Sarah N Bishop MD, FACS
Cleveland Clinic Foundation
2025-01-10
Presenter: Diwakar Phuyal
Affidavit:
Yes
Director Name: Raymond Isakov
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background:
Robotic harvest of the deep inferior epigastric perforator (DIEP) flap is gaining traction among plastic surgeons. However, its use is often limited to cases with short intramuscular length of the perforator (< 4cm) due to the need for larger anterior fascial incision.
Case:
We present a case of robotic-assisted transabdominal preperitoneal harvest of an 18 cm pedicle, including 9.1 cm intramuscular, through a 3.5 cm fascial incision. The patient had uneventful intraoperative and postoperative course.
Discussion/Conclusion
Robotic DIEP harvest aims to reduce donor-site morbidity, but its adoption is limited by the length of the intramuscular course. Utilizing robotics instead of the open approach for intramuscular course dissection can expand its application by reducing the anterior rectus fascia incision. Moreover, using robot makes it feasible for the robotic assisted surgeon to take the most suitable perforator for flap perfusion.
