Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota.
J Reconstr Microsurg. 2020 Jun;36(5):362-368. doi: 10.1055/s-0040-1701666. Epub 2020 Feb 27.
The deep inferior epigastric perforator (DIEP) flap is the most common perforator flap for microsurgical breast reconstruction. Contrary to the conventional open approach, robotic-assisted DIEP flap harvest intends to preserve ARS integrity, thereby reducing the morbidity. We assessed the feasibility and compared performance outcomes of a robotic, cadaveric training model for DIEP flap harvest using two approaches: transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP).
A robotics system (da Vinci Xi) was applied in conjunction with a cadaveric training model. Ports were placed in the abdominal wall to triangulate each DIEP flap. Surgical time and technical characteristics were recorded. Values were analyzed and compared.
Eight female cadavers (16 hemi-DIEP flaps) were dissected: 50% TAPP and 50% TEP approaches. Mean harvest time was 56 minutes (range: 48-74 minutes) and 65 minutes (range: 60-83 minutes) for TAPP versus TEP groups, respectively ( < 0.05). Mean pedicle dissection time was 36 minutes (range: 25-40 minutes) and 39 minutes (range: 30-42 minutes) for TAPP versus TEP groups, respectively ( > 0.05). Intra-abdominal contents were manipulated twice on average in the TAPP group versus 0 times in the TEP group ( < 0.05). One TAPP case had an injury to the bowel, and one TEP case was converted to conventional open due to pneumoperitoneum.
Robotic-assisted DIEP flap harvest represents a technological enhancement for advanced regenerative plastic surgery. Our model demonstrated both TAPP and TEP are feasible, with TEP less invasive, preserving the posterior rectus sheath, and decreasing complication risks. However, there is a steeper and longer learning curve for TEP.
深下腹壁穿支皮瓣（DIEP）是显微乳房重建中最常用的穿支皮瓣。与传统的开放式方法相反，机器人辅助 DIEP 皮瓣采集旨在保留 ARS 完整性，从而降低发病率。我们评估了使用两种方法（经腹前腹膜前（TAPP）和完全腹膜外（TEP））进行机器人辅助 DIEP 皮瓣采集的可行性，并比较了性能结果。
使用机器人系统（达芬奇 Xi）结合尸体训练模型进行操作。在腹壁上放置端口以三角化每个 DIEP 皮瓣。记录手术时间和技术特点。分析并比较了数值。
解剖了 8 具女性尸体（16 个半 DIEP 皮瓣）：50% TAPP 和 50% TEP 方法。TAPP 组的平均采集时间为 56 分钟（范围：48-74 分钟），TEP 组为 65 分钟（范围：60-83 分钟）（<0.05）。TAPP 组的蒂部解剖时间平均为 36 分钟（范围：25-40 分钟），TEP 组为 39 分钟（范围：30-42 分钟）（>0.05）。TAPP 组平均两次操作腹腔内脏器，而 TEP 组为 0 次（<0.05）。TAPP 组有 1 例肠损伤，1 例 TEP 组因气腹转为传统开放式。
机器人辅助 DIEP 皮瓣采集代表了先进再生整形外科的技术增强。我们的模型表明 TAPP 和 TEP 都是可行的，TEP 具有侵入性较小、保留后腹直肌鞘、降低并发症风险的优点。然而，TEP 的学习曲线更陡峭、更长。
