Department of Plastic Surgery, M.D. Anderson Cancer Center, The University of Texas, Houston, Texas 77030, USA.
J Reconstr Microsurg. 2012 Sep;28(7):457-64. doi: 10.1055/s-0032-1315789. Epub 2012 Jun 28.
Minimally invasive harvest of the latissimus dorsi (LD) muscle is a desirable goal because of both the wide utility of this muscle and the length of incision required to harvest it. In this study, robotic harvest of the LD muscle was evaluated in a cadaver model and clinical series. Ten LD flaps were robotically harvested in eight cadavers. Positioning, port placement, procedural steps, instrumentation, and technical obstacles were all critically analyzed and reported. After modifying the technique based on experience gained in the cadaver study, eight LD muscles were robotically harvested and transferred in eight patients. Access included a short axillary incision and two additional port sites along the anterior border of the muscle. Insufflation was used to maintain the optical cavity. Indications included pedicled flaps for implant-based breast reconstruction and free flaps for scalp reconstruction. All flaps were successfully transferred without converting to open technique. In the clinical series, average time for setup and port placement was 23 minutes, and average robotic time was 1 hour and 51 minutes. There were no major complications. Robotic harvest of the LD is feasible and effective and permits full muscle harvest without a visible incision.
微创获取 Latissimus dorsi（LD）肌肉是一个理想的目标，因为这种肌肉的用途广泛，而且需要切开很长的切口才能获取它。在这项研究中，我们在尸体模型和临床系列中评估了机器人获取 LD 肌肉的方法。在 8 具尸体中，我们使用机器人技术成功地采集了 10 个 LD 皮瓣。我们对定位、端口放置、操作步骤、器械使用和技术障碍进行了严格的分析和报告。在根据尸体研究获得的经验对技术进行修改后，我们又在 8 名患者中成功地使用机器人技术采集和转移了 8 块 LD 肌肉。手术入路包括短的腋窝切口和沿着肌肉前缘的另外两个端口位置。我们使用充气来维持光学腔。手术适应证包括基于植入物的乳房重建的带蒂皮瓣和头皮重建的游离皮瓣。所有皮瓣均成功转移，无需转为开放手术。在临床系列中，设备设置和端口放置的平均时间为 23 分钟，机器人操作的平均时间为 1 小时 51 分钟。没有出现主要并发症。机器人获取 LD 肌肉是可行且有效的，可实现完整的肌肉采集，而无需可见的切口。
