Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
J Plast Reconstr Aesthet Surg. 2021 Jun;74(6):1203-1212. doi: 10.1016/j.bjps.2020.10.098. Epub 2020 Nov 9.
We present a comparative series to utilize minimally invasive endoscopic, total extraperitoneal laparoscopic (TEP-lap), and transabdominal preperitoneal robotic perforator (TAP-RAP) harvest of the deep inferior epigastric (DIE) vessels for autologous breast reconstruction (ABR) to mitigate donor site morbidity. We hypothesized that TEP-lap and TAP-RAP harvests of abdominal-based free flaps are safe techniques associated with decreased fascial incision when compared with the endoscopic harvest.
We designed a retrospective cohort series of subjects with newly diagnosed breast cancer who presented for ABR using endoscopic (control), laparoscopic, or robotic assistance between September 2017 and April 2019. The primary outcome variables were flap success (i.e., absence of perioperative flap loss), fascial incision length, and intraoperative complications. Secondary variables included operating time, costs, and postoperative complications within 90 days (arterial thrombosis, venous congestion, bulge/hernia, and operative revision). Exclusion criteria included < 90 days follow-up.
In total 94, 38, and 3 subjects underwent endoscopic, TEP-lap, and TAP-RAP flap harvests. Mean lengths of fascial incisions for the endoscopic and laparoscopic cohorts were 4.5 ± 0.5 cm and 2.0 ± 0.6 cm (p < 0.0001), while incision length depended on the concurrent procedure in the robotic cohort. No subjects required conversion to an open harvest. There were no bleeding complications, intra-abdominal injuries, flap losses, or abdominal bulges/hernias noted in the TEP-lap and TAP-RAP cohorts.
Minimally invasive DIEP flap harvest may decrease fascial injury when compared with conventional open harvest. There are significant trade-offs among harvest methods. TEP-lap harvest may better balance the trade-off related to abdominal wall morbidity.
我们呈现了一系列对比研究，旨在利用微创内镜、完全腹膜外腹腔镜（TEP-lap）和经腹腹膜前机器人穿孔器（TAP-RAP）收获深部腹壁下血管（DIEP），用于自体乳房重建（ABR），以减轻供区部位的发病率。我们假设与内镜收获相比，TEP-lap 和 TAP-RAP 收获腹部游离皮瓣是安全的技术，可减少筋膜切口。
我们设计了一项回顾性队列研究，纳入了 2017 年 9 月至 2019 年 4 月期间因 ABR 就诊的新诊断乳腺癌患者。主要结局变量为皮瓣成功（即无围手术期皮瓣丢失）、筋膜切口长度和术中并发症。次要变量包括手术时间、成本和术后 90 天内的并发症（动脉血栓形成、静脉充血、膨出/疝和手术修正）。排除标准包括随访时间<90 天。
共有 94、38 和 3 名患者接受了内镜、TEP-lap 和 TAP-RAP 皮瓣收获。内镜和腹腔镜组的筋膜切口平均长度分别为 4.5±0.5cm 和 2.0±0.6cm（p<0.0001），而机器人组的切口长度取决于同期手术。没有患者需要转为开放性收获。TEP-lap 和 TAP-RAP 组均未发生出血并发症、腹腔内损伤、皮瓣丢失或腹部膨出/疝。
与传统的开放性收获相比，微创 DIEP 皮瓣收获可能会减少筋膜损伤。收获方法之间存在显著的权衡取舍。TEP-lap 收获可能更好地平衡腹壁发病率相关的权衡取舍。
