From the Division of Plastic Surgery, Baylor College of Medicine; and the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer.
Plast Reconstr Surg. 2020 Dec;146(6):1221-1225. doi: 10.1097/PRS.0000000000007368.
Robotically assisted latissimus dorsi harvest permits harvest of the latissimus dorsi muscle without a back incision, as compared to the traditional open technique. The authors hypothesized that robotic harvest has lower donor-site complication rates, decreased opioid requirements, and a shorter length of stay than the traditional open technique.
A retrospective review was performed of all consecutive pedicled latissimus dorsi flaps for breast reconstruction between 2011 and 2015. All procedures were conducted by two surgeons who performed both robotic and open cases.
Fifty-two patients were identified; 25 underwent robotically assisted latissimus dorsi harvest and 27 underwent the open technique. Demographic data between the two groups were similar. Median length of stay for robotic harvest was shorter than that for the traditional technique (2 days versus 3 days; p = 0.031). Postoperative morphine requirement was less in the robotic compared to the traditional technique, but the difference was not significant (158 mg versus 184 mg; p = 0.826). Seroma rate was higher in the robotic group (16 percent versus 0 percent; p = 0.034). The mean duration of surgery was longer in the robotic cohort (388 minutes versus 311 minutes; p = 0.002).
This study demonstrates robotically assisted latissimus dorsi harvest as an effective alternative to the traditional open technique in select patients. Advantages of robotic harvest include no back scar, a shorter length of stay, and lower opioid requirements, although the difference was not significant; disadvantages include longer operative time and a higher seroma rate.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
与传统的开放式技术相比，机器人辅助 Latissimus dorsi 采集可以在不进行背部切口的情况下采集 Latissimus dorsi 肌肉。作者假设机器人采集具有更低的供体部位并发症发生率、减少阿片类药物需求以及较短的住院时间，优于传统的开放式技术。
对 2011 年至 2015 年间连续进行的所有带蒂 Latissimus dorsi 皮瓣乳房重建术进行回顾性分析。所有手术均由两位外科医生进行，他们既进行了机器人手术，也进行了开放式手术。
共确定了 52 例患者；25 例行机器人辅助 Latissimus dorsi 采集，27 例行开放式技术。两组患者的人口统计学数据相似。机器人采集的中位住院时间短于传统技术（2 天比 3 天；p = 0.031）。与传统技术相比，机器人采集术后吗啡需求量较低，但差异无统计学意义（158mg 比 184mg；p = 0.826）。机器人组的血清肿发生率较高（16%比 0%；p = 0.034）。机器人组的手术时间平均较长（388 分钟比 311 分钟；p = 0.002）。
本研究表明，在选择的患者中，机器人辅助 Latissimus dorsi 采集是传统开放式技术的有效替代方法。机器人采集的优点包括无背部疤痕、住院时间短和阿片类药物需求低，尽管差异无统计学意义；缺点包括手术时间较长和血清肿发生率较高。
临床问题/证据水平：治疗性，III 级。
