Objective
The Robotic-assisted surgeries has been applied in plastic surgery to assist in raising certain flaps with minimal invasive approaches. In highly selected patients, the delivery of Robotic-assisted approaches can significantly reduce incision of the anterior rectus sheath (ARS) to up to 3 cm with a lengthy pedicle dissected, and avoid splitting of rectus abdominal muscle to avoid injury to the motor nerve to the rectus abdominis muscle and reduce postoperative pain in harvesting free DIEP flap. This technique is expected to assist in reducing donor site morbidities and enhance postoperative recovery to a higher level. The purpose of this study is to summary our early experience to provide reference for further practice and clinical application.
Materials and Methods
A retrospective chart review was conducted to identify all patients who received free DIEP flap for unilateral microsurgical breast reconstruction from the senior author between Mar 2020 and Aug 2020. Patients were included when the free DIEP was harvested as a Robotic-assisted manner. Patients who received free DIEP flap harvest using conventional method were included as control. Demographic data and previous history of abdominal surgeries were identified. Flap and donor site related parameters, including the ischemia time of survival of the flaps, the size of the flap harvested, the number of perforators, the length of incision on anterior rectus sheath, the time for Robotic dissection of the pedicle of DIEP and suturing the peritoneum, complications from the donor site and pain score were retrospectively recorded.
Results
A total of 6 DIEP flaps were raised under the assistance of Robotic arm. Another 18 free DIEP flaps, which were harvested using conventional method for unilateral breast reconstruction were included as control group. All of the flaps in the two groups were transferred successfully with 100% successful rate. The size of flap, the number of perforators included, and the lengthy of the pedicle were without significant difference between groups. A significantly shorter incision of ARS was required for flap harvest in the Robotic-assisted group (2.333 ± 0.1667 vs. 8.028 ± 0.2785, p<0.0001). A significantly longer ischemia time was required for the Robotic DIEP group (92.83 ± 15.23 vs. 62.06 ± 4.786, p=0.0167). One donor site morbidity presented in the Robot DIEP group with poor wound healing, which required surgical suture. No donor site morbidities presented in the conventional DIEP group. (p=0.2500)
Conclusions
In comparison to conventional DIEP flap harvest, Robotic-assisted approach effectively reduced the incision of the ARS to allow pedicle dissection with similar pedicle length. Robotic-assisted harvest of free DIEP flap is a safe and feasible approach when conducted by well experienced general surgeon and reconstructive microsurgeon.

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