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Robotic-Assisted Harvest of the Deep Inferior Epigastric Perforator Flap for Breast Reconstruction: A case series on TEP and TAP approach
Sarah N Bishop, MD; Risal Djohan, MD, Diwakar Phuyal, MBBS, Rachel Schafer, MPH, Raffi Gurunian MD, PhD, Clayton Petro, MD, Lucas Beffa, MD, Graham Schwarz, MD, MSE, 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.)
Introduction:
Harvesting the deep inferior epigastric perforator (DIEP) flap through an open approach traditionally involves a lengthy fascial incision, which increases abdominal wall morbidity. Robotic-assisted harvesting techniques aim to minimize the anterior fascial incision, reducing complications and improving recovery.
The robotic DIEP flap can be harvested using either the transabdominal preperitoneal (TAPP) or the totally extraperitoneal (TEP) approach. Both methods leverage robotic technology to improve precision, facilitate smaller incisions, and decrease postoperative morbidity.
Method:
A case series of 29 patients who underwent robotic DIEP flap harvesting from 2022 to 2024 was analyzed. Data on patient demographics, surgical details, and postoperative complications were collected and evaluated.
Result:
The mean patient age was 52.14 ± 9.12 years, and the mean BMI was 29.17 ± 3.82 kg/m². The TEP approach was used in 21 patients, and the TAPP approach in 8 patients. The mean fascial incision length was 3.7 cm [IQR 2.5–6], and the mean pedicle length was 14 cm [IQR 10.25–14.88]. Fascial plication was performed in 2 cases.
Complications included 1 total flap loss, 1 infection, 1 deep vein thrombosis (DVT), and 6 wound-related issues. The median hospital stay was 3 days [IQR 2–4], with 2 readmissions. The mean operative time was 668.57 ± 152 minutes.
Conclusion:
Robotic-assisted DIEP flap harvesting using TEP and TAPP approaches is a safe and effective method, significantly reducing fascial incision length while maintaining favorable outcomes.
