Morkuzu Suat, Bayezid K Can, Ozmen Berk B, Eren Seyma Fatima, Farhat Souha, McLennan Alexandra L, James Andrew J, Nikkhah Dariush, Azoury Saïd C, Djohan Risal S, Bishop Sarah N, Schwarz Graham S
Department of Anatomy, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
Department of Burns and Plastic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
J Craniofac Surg. 2025;36(1):362-367. doi: 10.1097/SCS.0000000000010790. Epub 2024 Oct 23.
The integration of robotic technology into surgical procedures has gained considerable attention for its promise to enhance a variety of clinical outcomes. Robotic deep inferior epigastric perforator (DIEP) flap harvest has emerged as a novel approach for autologous breast reconstruction. This systematic review aims to provide a comprehensive overview of the current techniques, outcomes, and complications of robotic DIEP flap surgery.
A systematic literature search was conducted after PRISMA 2020 guidelines across databases including PubMed, Embase, Google Scholar, and Web of Science from 2000 to 2023. Articles exploring robotic DIEP flap harvest for breast reconstruction were assessed to compare operative techniques, clinical outcomes, and complications. The risk of bias was evaluated using ROBINS-I and the Newcastle-Ottawa scale.
Fourteen studies involving 108 patients were included. Three studies used a totally extraperitoneal (TEP) technique, whereas 11 studies used a transabdominal preperitoneal (TAPP) approach. Preoperative planning utilized computed tomography angiography and magnetic resonance angiography imaging. The mean robotic operative time was 64 minutes, with total operative times averaging 574 minutes for TAPP and 497 minutes for TEP. The mean length of stay was 5 days, and the mean fascial incision length was 3 cm. Overall complication rate was 14.9%, with no significant difference compared with conventional DIEP flap procedures.
Robotic DIEP flap harvest is a promising technique that may reduce postoperative pain and limiting abdominal donor site morbidity. Potential limitations include longer operative times, variable hospital stays, and increased costs.
将机器人技术整合到外科手术中因其有望改善多种临床结果而备受关注。机器人下腹壁深穿支（DIEP）皮瓣切取已成为自体乳房重建的一种新方法。本系统评价旨在全面概述机器人DIEP皮瓣手术的当前技术、结果和并发症。
根据PRISMA 2020指南，在2000年至2023年期间对包括PubMed、Embase、谷歌学术和科学网在内的数据库进行系统文献检索。对探索机器人DIEP皮瓣切取用于乳房重建的文章进行评估，以比较手术技术、临床结果和并发症。使用ROBINS-I和纽卡斯尔-渥太华量表评估偏倚风险。
纳入14项研究，共108例患者。3项研究采用完全腹膜外（TEP）技术，11项研究采用经腹腹膜前（TAPP）方法。术前规划采用计算机断层血管造影和磁共振血管造影成像。机器人平均手术时间为64分钟，TAPP的总手术时间平均为574分钟，TEP为497分钟。平均住院时间为5天，平均筋膜切口长度为3厘米。总体并发症发生率为14.9%，与传统DIEP皮瓣手术相比无显著差异。
机器人DIEP皮瓣切取是一种有前景的技术，可能会减轻术后疼痛并减少腹部供区并发症。潜在的局限性包括手术时间较长、住院时间不一和成本增加。
