McCreery Chloe V, Liu Amy, Deptula Peter, Murariu Daniel
John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA.
Department of Surgery, John A. Burns School of Medicine, University of Hawai'I, Queen's University Tower, 1356 Lusitana Street, 6th Floor, Honolulu, HI 96813, USA.
J Clin Med. 2025 Jul 23;14(15):5204. doi: 10.3390/jcm14155204.
Robotic deep inferior epigastric artery perforator (DIEP) flap surgery is a technique used for autologous breast reconstruction to maintain the integrity of the rectus abdominis muscle while also utilizing robotic assistance for flap harvest. This study assesses postoperative outcomes of patients undergoing robotic DIEP flap reconstruction through the measurement of postoperative pain, narcotics use, and antiemetic usage. : A retrospective analysis was performed for patients undergoing robotic DIEP flap breast reconstruction between March 2024 and March 2025. Postoperative pain scores (1-10 scale), narcotics usage (measured in oral morphine equivalents), antiemetic usage, and complications were recorded. Patient outcomes were compared to a control group of 40 patients who had undergone abdominal-based free flap breast reconstruction. : Overall, 14 patients underwent robotic DIEP flap breast reconstruction, representing 24 breasts. The average patient age was 56.5 (range: 30-73). Ten patients underwent bilateral breast reconstruction, and four underwent unilateral breast reconstruction. The average length of stay postoperatively was 4.86 days (±1.23 days), and the return of bowel function occurred in 1.29 days (±0.47 days). No patients experienced an unplanned return to the OR or flap failure. Average pain scores on postoperative day 1 (POD1), 2 (POD2), and 3 (POD3) were 4.0 (±0.6), 3.4 (±0.6), and 2.93 (±0.5), respectively. Average antiemetic usage totalled 1.25 doses (±0.25). Average daily OME use was 27.7 (±5.0) for POD1, 25.96 (±6.3) for POD2, and 21.23 (±7.11) for POD3. This averaged to a total hospital OME use of 74.9 (±15.7) per patient. Patients undergoing robotic DIEP flap reconstruction required a significantly lower narcotics dosage, as well as a lower antiemetic dosage, during the first three days postoperatively compared to the control abdominal free flap group. Average pain scores in the robotic DIEP flap reconstruction patient group were also significantly decreased, specifically in POD2 and POD3. : The robotic DIEP flap offers advantages in autologous breast reconstruction compared to other abdominal free flap reconstructive methods. In this limited retrospective study, the use of the robotic DIEP flap lowers chances of flap failure and complications, while also improving narcotics use, antiemetic use, and postoperative pain.
机器人辅助下深部腹壁下动脉穿支（DIEP）皮瓣手术是一种用于自体乳房重建的技术，该技术在保留腹直肌完整性的同时，利用机器人辅助进行皮瓣切取。本研究通过测量术后疼痛、麻醉药物使用情况和止吐药物使用情况，评估接受机器人辅助DIEP皮瓣重建患者的术后结局。：对2024年3月至2025年3月期间接受机器人辅助DIEP皮瓣乳房重建的患者进行回顾性分析。记录术后疼痛评分（1 - 10分制）、麻醉药物使用量（以口服吗啡当量衡量）、止吐药物使用情况及并发症。将患者的结局与40例接受腹部游离皮瓣乳房重建的对照组患者进行比较。：总体而言，14例患者接受了机器人辅助DIEP皮瓣乳房重建，共涉及24个乳房。患者平均年龄为56.5岁（范围：30 - 73岁）。10例患者接受双侧乳房重建，4例接受单侧乳房重建。术后平均住院时间为4.86天（±1.23天），肠功能恢复时间为1.29天（±0.47天）。没有患者经历计划外重返手术室或皮瓣失败。术后第1天（POD1）、第2天（POD2）和第3天（POD3）的平均疼痛评分分别为4.0（±0.6）、3.4（±0.6）和2.93（±0.5）。平均止吐药物使用总量为1.25剂（±0.25）。POD1的平均每日口服吗啡当量（OME）使用量为27.7（±5.0），POD2为25.96（±6.3），POD3为21.23（±7.11）。每位患者的医院总OME使用量平均为74.9（±15.7）。与对照组腹部游离皮瓣组相比，接受机器人辅助DIEP皮瓣重建的患者在术后前三天所需的麻醉药物剂量和止吐药物剂量均显著更低。机器人辅助DIEP皮瓣重建患者组的平均疼痛评分也显著降低，尤其是在POD2和POD3。：与其他腹部游离皮瓣重建方法相比，机器人辅助DIEP皮瓣在自体乳房重建中具有优势。在这项有限的回顾性研究中，使用机器人辅助DIEP皮瓣可降低皮瓣失败和并发症的几率，同时还能改善麻醉药物使用、止吐药物使用情况及术后疼痛。
