Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA.
Department of Urology, New York University Langone Health, New York, New York, USA.
Microsurgery. 2022 May;42(4):319-325. doi: 10.1002/micr.30856. Epub 2022 Jan 5.
Reducing donor site morbidity after deep inferior epigastric artery perforator (DIEP) flap harvest relies mainly upon maintaining integrity of the anterior rectus sheath fascia. The purpose of this study is to describe our minimally-invasive technique for robotic DIEP flap harvest.
A retrospective review of four patients undergoing seven robotic-assisted DIEP flaps from 2019 to 2020 was conducted. Average patient age and BMI were 52 years (range: 45-60 years) and 26.7 kg/m (range: 20.6-32.4 kg/m ), respectively. Average follow-up was 6.31 months (range: 5.73-7.27 months). Robotic flap harvest was performed with intramuscular perforator dissection in standard fashion, followed by the transabdominal preperitoneal (TAPP) approach to DIEP pedicle harvest using the da Vinci Xi robot. Data was collected on demographic information, perioperative characteristics. Primary outcomes included successful flap harvest as well as donor site morbidity (e.g., abdominal bulge, hernia, bowel obstruction, etc.).
All four patients underwent bilateral abdominally-based free flap reconstruction. Three patients received bilateral robotic DIEP flaps, and one patient underwent unilateral robotic DIEP flap reconstruction. The da Vinci Xi robot was used in all cases. Average flap weight and pedicle length were 522 g (range: 110-809 g) and 11.2 cm (range: 10-12 cm), respectively. There were no flap failures, and no patient experienced abdominal wall donor site morbidity on physical exam.
While further studies are needed to validate its use, this report represents the largest series of robotic DIEP flap harvests to date and is a valuable addition to the literature.
降低深下腹直肌穿支皮瓣（DIEP）游离皮瓣采集后的供区并发症主要依赖于保持前腹直肌鞘筋膜的完整性。本研究旨在描述我们用于机器人 DIEP 皮瓣采集的微创技术。
回顾性分析了 2019 年至 2020 年间 4 名患者的 7 例机器人辅助 DIEP 皮瓣游离术。患者的平均年龄和 BMI 分别为 52 岁（范围：45-60 岁）和 26.7kg/m（范围：20.6-32.4kg/m）。平均随访时间为 6.31 个月（范围：5.73-7.27 个月）。机器人皮瓣游离术采用标准的肌内穿支解剖，然后采用达芬奇 Xi 机器人进行经腹腹膜前（TAPP）方法采集 DIEP 蒂。收集人口统计学信息、围手术期特征。主要结果包括皮瓣游离成功和供区并发症（如腹部膨出、疝、肠梗阻等）。
所有 4 名患者均接受了双侧腹部游离皮瓣重建。3 例患者接受了双侧机器人 DIEP 皮瓣游离术，1 例患者接受了单侧机器人 DIEP 皮瓣游离术重建。所有病例均使用达芬奇 Xi 机器人。平均皮瓣重量和蒂长度分别为 522g（范围：110-809g）和 11.2cm（范围：10-12cm）。没有皮瓣失败，所有患者体格检查均未发现腹壁供区并发症。
虽然需要进一步的研究来验证其使用，但本报告代表了迄今为止最大的机器人 DIEP 皮瓣游离术系列，是对文献的有价值的补充。
