Gundlapalli Vinay S, Ogunleye Adeyemi A, Scott Kiandra, Wenzinger Eric, Ulm Jason P, Tavana Lance, Pullatt Rana C, Delaney Kevin O
Division of Plastic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
Division of Gastrointestinal/Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
Microsurgery. 2018 Sep;38(6):702-705. doi: 10.1002/micr.30297. Epub 2018 Jan 25.
The deep inferior epigastric perforator (DIEP) flap is a mainstay of autologous breast reconstruction. The da Vinci robot has recently been adapted for an increasing number of reconstructive surgeries. The literature has yet to describe its use for the intra-abdominal harvest of the deep inferior epigastric vessels (DIEV) during DIEP flap breast reconstruction. We show the use of the da Vinci robotic surgical system for the intra-abdominal dissection of DIEV during delayed breast reconstruction with a DIEP flap in a 51-year-old female who had undergone a right modified radical mastectomy. After dissecting the flap from the anterior abdominal wall leaving only the targeted perforating vessels intact, a 1.5 cm fascial incision was made adjacent to the perforator and the vessels were dissected to below the level of the fascia. The intra-abdominal robotic-assisted dissection of the DIEV up to the perforator was then completed. The DIEV were divided at their origin using the robot and the flap removed from the abdomen for subsequent reconstruction. This technique enabled improved precision of flap harvest while also decreasing the donor-site morbidity by minimizing the incision length of the anterior rectus sheath. The patient had an uneventful postoperative course and, at 9-month follow-up, exhibited no evidence of flap or donor-site complications, specifically hernia or bulge. This novel approach for the harvest of a DIEP flap introduces an alternative technique to the conventional DIEP flap procedure in the appropriate patient population. Risks inherent to this technique as well as additional costs must be considered.
腹壁下深动脉穿支（DIEP）皮瓣是自体乳房重建的主要方式。近年来，达芬奇机器人已越来越多地应用于各类重建手术。目前尚无文献描述其在DIEP皮瓣乳房重建术中用于腹内获取腹壁下深血管（DIEV）的情况。我们展示了在一名51岁、已行右侧改良根治性乳房切除术的女性患者延迟乳房重建术中，使用达芬奇机器人手术系统进行腹内DIEV解剖以获取DIEP皮瓣的过程。在从腹前壁分离皮瓣仅保留目标穿支血管完整后，在穿支血管旁做一个1.5 cm的筋膜切口，将血管解剖至筋膜下方。然后通过机器人辅助在腹内完成DIEV至穿支血管的解剖。使用机器人在血管起始处离断DIEV，将皮瓣从腹部取下用于后续重建。该技术提高了皮瓣获取的精度，同时通过最小化腹直肌前鞘的切口长度降低了供区并发症。患者术后恢复顺利，9个月随访时未发现皮瓣或供区并发症，特别是未出现疝气或腹壁膨出。这种获取DIEP皮瓣的新方法为合适的患者群体提供了一种替代传统DIEP皮瓣手术的技术。必须考虑该技术固有的风险以及额外的费用。
