Abstract
Harvest of muscle flaps traditionally requires long incisions that allow access to muscle origin, insertion, and pedicle. Because some muscles such as the latissimus dorsi and rectus abdominis are large, incisions can be anywhere from 20 to 30 cm in length. These donor sites are conspicuously located on the abdomen and back and are the source of morbidity in the form of cosmesis, seroma, and hernia. The robotic interface has supplied the necessary exposure and picture clarity through high-resolution, three-dimensional optics and the necessary precision instrumentation through wristed motion at the instrument tips to accomplish both muscle harvest and pedicle dissection. The robotic approaches that we describe, including the latissimus dorsi muscle and rectus abdominis muscle, are reproducible techniques for accomplishing muscle harvest without significant donor site morbidity. Both approaches take advantage of insufflation, gravity, precision instrumentation, and 3-dimensional imaging with multiple-angle scopes.
Robotic muscle harvest represents a tremendous step forwards in the ongoing quest to minimize donor site morbidity without compromising outcomes in reconstructive surgery.
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References
Ascherman JA, Seruya M, Bartsich SA (2008) Abdominal wall morbidity following unilateral and bilateral breast reconstruction with pedicled TRAM flaps: an outcomes analysis of 117 consecutive patients. Plast Reconstr Surg 121:1–8
Bartlett SP, May JW Jr, Yaremchuk MJ (1981) The latissimus dorsi muscle: a fresh cadaver study of the primary neurovascular pedicle. Plast Reconstr Surg 67:631–636
Bass LS, Karp NS, Benacquista T et al (1995) Endoscopic harvest of the rectus abdominis free flap: balloon dissection in the fascial plane. Ann Plast Surg 34:274–279; discussion 279–280
Bostwick J 3rd, Vasconez LO, Jurkiewicz MJ (1978) Breast reconstruction after a radical mastectomy. Plast Reconstr Surg 61:682–693
Chandra V, Nehra D, Parent R et al (2010) A comparison of laparoscopic and robotic assisted suturing performance by experts and novices. Surgery 147:830–839
Chun YS, Sinha I, Turko A et al (2010) Comparison of morbidity, functional outcome, and satisfaction following bilateral TRAM versus bilateral DIEP flap breast reconstruction. Plast Reconstr Surg 126:1133–1141
Fine NA, Orgill DP, Pribaz JJ (1994) Early clinical experience in endoscopic-assisted muscle flap harvest. Ann Plast Surg 33:465–469; discussion 469–472
Germann G, Waag KL, Selle B et al (2006) Extremity salvage with a free musculocutaneous latissimus dorsi flap and free tendon transfer after resection of a large congenital fibro sarcoma in a 15-week-old infant. A case report. Microsurgery 26:429–431
Greensmith A, Januszkiewicz J, Poole G (2000) Rectus abdominis muscle free flap harvest by laparoscopic sheath-sparing technique. Plast Reconstr Surg 105:1438–1441
Kroll SS, Schusterman MA, Reece GP et al (1995) Abdominal wall strength, bulging, and hernia after TRAM flap breast reconstruction. Plast Reconstr Surg 96:616–619
Lim PC, Kang E, Park DH (2010) A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: a case-matched controlled study of the first one hundred twenty two patients. Gynecol Oncol 120:413–418
Lin CH, Wei FC, Levin LS et al (1999) Donor-site morbidity comparison between endoscopically assisted and traditional harvest of free latissimus dorsi muscle flap. Plast Reconstr Surg 104:1070–1077
Maxwell GP, McGibbon BM, Hoopes JE (1979) Vascular considerations in the use of a latissimus dorsi myocutaneous flap after a mastectomy with an axillary dissection. Plast Reconstr Surg 64:771–780
McCraw JB, Dibbell DG, Carraway JH (1977) Clinical definition of independent myocutaneous vascular territories. Plast Reconstr Surg 60:341–352
Miller MJ, Robb GL (1995) Endoscopic technique for free flap harvesting. Clin Plast Surg 22:755–773
Pomel C, Missana MC, Lasser P (2002) Endoscopic harvesting of the latissimus dorsi flap in breast reconstructive surgery. Feasibility study and review of the literature. Ann Chir 127:337–342 [French]
Ramakrishnan VV, Southern S, Villafane O (1997) Endoscopic harvest of the latissimus dorsi muscle using the balloon dissection technique. Plast Reconstr Surg 99:899–903; discussion 904–905
Ramakrishnan VV, Southern SJ (1997) Endoscopic rectus harvest: a simplified sheath-saving technique. Ann Plast Surg 39:573–577
Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526
Schneider WJ, Hill HL Jr, Brown RG (1977) Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg 30:277–281
Seitz IA, Adler N, Odessey E (2009) Latissimus dorsi/rib intercostal perforator myo-osseocutaneous free flap reconstruction in composite defects of the scalp: case series and review of literature. J Reconstr Microsurg 25:559–567
Suominen S, Asko-Seljavaara S, von Smitten K et al (1996) Sequelae in the abdominal wall after pedicled or free TRAM flap surgery. Ann Plast Surg 36:629–636
Tansini I (1906) Sopra il mio muovo processo di amputazione della mammella. Gazetta Medica Italiana 67:141
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Selber, J.C., Pedersen, J.C. (2013). Muscle Flaps. In: Liverneaux, P., Berner, S., Bednar, M., Parekattil, S., Mantovani Ruggiero, G., Selber, J. (eds) Telemicrosurgery. Springer, Paris. https://doi.org/10.1007/978-2-8178-0391-3_17
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DOI: https://doi.org/10.1007/978-2-8178-0391-3_17
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