Moreira Andrea, Bailey Elizabeth A, Chen Brian, Nelson William, Li Jenna, Fortunato Richard, Nosik Stanislav, Murariu Daniel
Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania.
Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
J Reconstr Microsurg. 2025 May;41(4):277-286. doi: 10.1055/s-0044-1788642. Epub 2024 Aug 5.
Traditional deep inferior epigastric artery perforator (DIEP) flap harvest splits the anterior sheath, weakening the abdominal wall and predisposing patients to bulge or hernia. Abdominal wall morbidity may be decreased using minimally invasive techniques. We refined a transabdominal approach to the robotic harvest of bilateral DIEP flaps.
A retrospective medical record study involving all patients who underwent bilateral or bipedicled robotic DIEP (rDIEP) or standard DIEP (sDIEP) flap harvest between July 2021 and September 2022. Outcomes included abdominal wall morbidity, total operative time, length of stay (LOS), and complications.
Forty-seven patients were included (48 sDIEP flaps, 46 rDIEP flaps) with no significant difference in patient characteristics. Fascial incision length in the rDIEP group was shorter (4.1 vs. 11.7 cm, < 0.001). Mesh reinforcement of the abdominal wall was used in 13/24 sDIEP and none in rDIEP patients ( < 0.001). Operative time was longer in the rDIEP cohort (739 vs. 630 minutes, = 0.013), although subanalysis showed no difference in the second half of the cohort. The average robotic dissection time was 135 minutes, which decreased significantly with the surgeon's experience. There were no intraoperative complications from using the robot. LOS was shorter with rDIEP but not statistically significant (3.9 vs. 4.3 days, = 0.157).
This study represents the most extensive cohort analysis of bilateral rDIEP flap harvest, offering a comprehensive comparison to traditional sDIEP. The initial results underscore the viability of robotic techniques for flap harvesting, highlighting potential advantages including reduced fascial incision length and decreased abdominal disruption. Furthermore, using robotics may obviate the necessity for fascial reinforcement with mesh.
传统的腹壁下动脉穿支（DIEP）皮瓣切取需要切开腹直肌前鞘，这会削弱腹壁强度，使患者易出现腹壁膨出或疝。采用微创技术可能会降低腹壁相关并发症的发生率。我们改进了一种经腹途径用于机器人辅助双侧DIEP皮瓣切取。
一项回顾性病历研究，纳入2021年7月至2022年9月期间所有接受双侧或双蒂机器人辅助DIEP（rDIEP）或标准DIEP（sDIEP）皮瓣切取的患者。观察指标包括腹壁并发症、总手术时间、住院时间（LOS）和并发症。
共纳入47例患者（48例sDIEP皮瓣，46例rDIEP皮瓣），患者特征无显著差异。rDIEP组的筋膜切口长度较短（4.1 cm对11.7 cm，<0.001）。13/24例sDIEP患者使用了腹壁补片加强，而rDIEP组患者均未使用（<0.001）。rDIEP组的手术时间较长（739分钟对630分钟，P = 0.013），尽管亚组分析显示队列后半部分无差异。机器人平均分离时间为135分钟，随着术者经验的增加显著缩短。使用机器人未出现术中并发症。rDIEP组的住院时间较短，但差异无统计学意义（3.9天对4.3天，P = 0.157）。
本研究是对双侧rDIEP皮瓣切取最广泛的队列分析，与传统sDIEP进行了全面比较。初步结果强调了机器人技术用于皮瓣切取的可行性，突出了潜在优势，包括缩短筋膜切口长度和减少腹壁破坏。此外，使用机器人技术可能无需用补片进行筋膜加强。
