Minimally Invasive Approaches to DIEP flap Harvest: A review of current data

 

 Buy Article Permissions and Reprints

Abstract

Breast cancer is the most prevalent cancer in the female population. Autologous tissue is often used for reconstruction after mastectomy. The deep inferior epigastric (DIEP) flap is a favorite for breast reconstruction because it entails careful perforator dissection with less muscle destruction. Recently, minimally invasive techniques in DIEP flap harvest have increased in popularity but their complication rate and security profile may vary from one technique to another. The purpose of this review study is to evaluate and compare two minimally invasive surgical approaches to abdominal based free flap harvest: the transabdominal pre-peritoneal robotic assisted DIEP flap harvest and total extra-peritoneal laparoscopic DIEP flap harvest.

Zusammenfassung

Brustkrebs stellt die häufigste maligne Erkrankung der Frau dar. Die Brustekonstruktion mit freien Lappenplastiken und autologem Gewebe ist ein Standardverfahren nach einer Mastektomie. Das am weitesten verbreitete Verfahren ist die A. epigastrica inferior Perforans-Lappenplastik (DIEP-Flap), die eine möglichst atraumatische Präparation des Perforans-Gefäßes mit möglichst geringer Verletzung des M. rectus abdominis zum Ziel hat. In jüngerer Zeit werden minimalinvasive Verfahren zunehmend eingesetzt, obwohl die Komplikationsraten und das Sicherheitsprofil bei unterschiedlichen Techniken bislang nicht gleichwertig zu den Standardverfahren ist. Diese Übersichtsarbeit bewertet und vergleicht zwei neue minimalinvasive chirurgische Verfahren für die Hebung von abdominalen freien Lappenplastiken: die transabdominale preperitoneale Roboter-gestützte DIEP Lappenhebung und die totale extra-peritoneale laparoskopische DIEP-Lappenhebung.

Publication History

Received: 06 February 2022

Accepted: 25 August 2022

Article published online:
21 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A.. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424 Epub 20180912 DOI: 10.3322/caac.21492.PubMed PMID: 30207593.
  CrossrefPubMedGoogle Scholar
• 2 Gart MS, Smetona JT, Hanwright PJ, Fine NA, Bethke KP, Khan SA, Wang E, Kim JY.. Autologous options for postmastectomy breast reconstruction: a comparison of outcomes based on the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2013; 216: 229-38 Epub 20121202 DOI: 10.1016/j.jamcollsurg.2012.11.003.PubMed PMID: 23211118.
  CrossrefPubMedGoogle Scholar
• 3 Fischer JP, Nelson JA, Cleveland E, Sieber B, Rohrbach JI, Serletti JM, Kanchwala S.. Breast reconstruction modality outcome study: a comparison of expander/implants and free flaps in select patients. Plast Reconstr Surg 2013; 131: 928-34 DOI: 10.1097/PRS.0b013e3182865977.. PubMed PMID: 23629074
  CrossrefPubMedGoogle Scholar
• 4 Blondeel PN, Boeckx WD.. Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery. Br J Plast Surg 1994; 47: 495-501 DOI: 10.1016/0007-1226(94)90033-7.. PubMed PMID: 7952820
  CrossrefPubMedGoogle Scholar
• 5 Selber JC, Fosnot J, Nelson J, Goldstein J, Bergey M, Sonnad S, Serletti JM.. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: Part II. Bilateral reconstruction. Plast Reconstr Surg 2010; 126: 1438-53 DOI: 10.1097/PRS.0b013e3181ea42ed.. PubMed PMID: 21042100
  CrossrefPubMedGoogle Scholar
• 6 Man LX, Selber JC, Serletti JM.. Abdominal wall following free TRAM or DIEP flap reconstruction: a meta-analysis and critical review. Plast Reconstr Surg 2009; 124: 752-64 DOI: 10.1097/PRS.0b013e31818b7533.. PubMed PMID: 19342994
  CrossrefPubMedGoogle Scholar
• 7 Vyas RM, Dickinson BP, Fastekjian JH, Watson JP, DaLio AL, Crisera CA.. Risk factors for abdominal donor-site morbidity in free flap breast reconstruction. Plast Reconstr Surg 2008; 121: 1519-26 DOI: 10.1097/PRS.0b013e31816b1458.. PubMed PMID: 18453973
  CrossrefPubMedGoogle Scholar
• 8 Ochoa O, Chrysopoulo M, Nastala C, Ledoux P, Pisano S.. Abdominal wall stability and flap complications after deep inferior epigastric perforator flap breast reconstruction: does body mass index make a difference? Analysis of 418 patients and 639 flaps. Plast Reconstr Surg 2012; 130: 21e-33e DOI: 10.1097/PRS.0b013e3182547d09.. PubMed PMID: 22743936
  CrossrefPubMedGoogle Scholar
• 9 Haddock NT, Culver AJ, Teotia SS.. Abdominal weakness, bulge, or hernia after DIEP flaps: An algorithm of management, prevention, and surgical repair with classification. J Plast Reconstr Aesthet Surg 2021; 74: 2194-201 Epub 20201226 DOI: 10.1016/j.bjps.2020.12.044.PubMed PMID: 33487570.
  CrossrefPubMedGoogle Scholar
• 10 Rozen WM, Ashton MW, Kiil BJ, Grinsell D, Seneviratne S, Corlett RJ, Taylor GI.. Avoiding denervation of rectus abdominis in DIEP flap harvest II: an intraoperative assessment of the nerves to rectus. Plast Reconstr Surg 2008; 122: 1321-5 DOI: 10.1097/PRS.0b013e3181881e18.. PubMed PMID: 18971714
  CrossrefPubMedGoogle Scholar
• 11 Colohan S, Maia M, Langevin CJ, Donfrancesco A, Shirvani A, Trussler AP, Saint-Cyr M.. The short- and ultrashort-pedicle deep inferior epigastric artery perforator flap in breast reconstruction. Plast Reconstr Surg 2012; 129: 331-40 DOI: 10.1097/PRS.0b013e31823ae9a3.. PubMed PMID: 22286415
  CrossrefPubMedGoogle Scholar
• 12 Shakir S, Spencer AB, Piper M, Kozak GM, Soriano IS, Kanchwala SK.. Laparoscopy allows the harvest of the DIEP flap with shorter fascial incisions as compared to endoscopic harvest: A single surgeon retrospective cohort study. J Plast Reconstr Aesthet Surg 2021; 74: 1203-12 Epub 20201109 DOI: 10.1016/j.bjps.2020.10.098.PubMed PMID: 33268043.
  CrossrefPubMedGoogle Scholar
• 13 Shakir S, Spencer AB, Kozak GM, Nathan SL, Soriano IS, Kanchwala SK.. Laparoscopically Assisted DIEP Flap Harvest Minimizes Fascial Incision in Autologous Breast Reconstruction. Plast Reconstr Surg 2020; 146: 265e-75e DOI: 10.1097/PRS.0000000000007048.. PubMed PMID: 32842099
  CrossrefPubMedGoogle Scholar
• 14 Hivelin M, Soprani A, Schaffer N, Hans S, Lantieri L.. Minimally Invasive Laparoscopically Dissected Deep Inferior Epigastric Artery Perforator Flap: An Anatomical Feasibility Study and a First Clinical Case. Plast Reconstr Surg 2018; 141: 33-9 DOI: 10.1097/PRS.0000000000003989.. PubMed PMID: 28915211
  CrossrefPubMedGoogle Scholar
• 15 Autorino R, Kaouk JH, Stolzenburg JU, Gill IS, Mottrie A, Tewari A, Cadeddu JA.. Current status and future directions of robotic single-site surgery: a systematic review. Eur Urol 2013; 63: 266-80 Epub 20120823 DOI: 10.1016/j.eururo.2012.08.028.PubMed PMID: 22940173.
  CrossrefPubMedGoogle Scholar
• 16 Kenngott HG, Muller-Stich BP, Reiter MA, Rassweiler J, Gutt CN.. Robotic suturing: technique and benefit in advanced laparoscopic surgery. Minim Invasive Ther Allied Technol 2008; 17: 160-7 DOI: 10.1080/13645700802103381.. PubMed PMID: 18609002
  CrossrefPubMedGoogle Scholar
• 17 Gundlapalli VS, Ogunleye AA, Scott K, Wenzinger E, Ulm JP, Tavana L, Pullatt RC, Delaney KO.. Robotic-assisted deep inferior epigastric artery perforator flap abdominal harvest for breast reconstruction: A case report. Microsurgery 2018; 38: 702-5 Epub 20180125 DOI: 10.1002/micr.30297.PubMed PMID: 29368352.
  CrossrefPubMedGoogle Scholar
• 18 Ogunleye AA, Gundlapalli VS, Pullatt RC, Armstrong MB, Delaney KO.. Minimally Invasive Laparoscopically Dissected Deep Inferior Epigastric Artery Perforator Flap: An Anatomical Feasibility Study and a First Clinical Case. Plast Reconstr Surg 2018; 142: 786e-7e DOI: 10.1097/PRS.0000000000004894.. PubMed PMID: 30222669
  CrossrefPubMedGoogle Scholar
• 19 Piper M, Ligh CA, Shakir S, Messa C, Soriano I, Kanchwala S.. Minimally invasive robotic-assisted harvest of the deep inferior epigastric perforator flap for autologous breast reconstruction. J Plast Reconstr Aesthet Surg 2021; 74: 890-930 Epub 20200920 DOI: 10.1016/j.bjps.2020.08.106.PubMed PMID: 33004296.
  CrossrefPubMedGoogle Scholar
• 20 Selber JC.. The Robotic DIEP Flap. Plast Reconstr Surg 2020; 145: 340-3 DOI: 10.1097/PRS.0000000000006529.. PubMed PMID: 31985617
  CrossrefPubMedGoogle Scholar
• 21 Struk S, Sarfati B, Leymarie N, Missistrano A, Alkhashnam H, Rimareix F, Kolb F, Honart JF.. Robotic-assisted DIEP flap harvest: A feasibility study on cadaveric model. J Plast Reconstr Aesthet Surg 2018; 71: 259-61 Epub 20171106 DOI: 10.1016/j.bjps.2017.10.028.PubMed PMID: 29198982.
  CrossrefPubMedGoogle Scholar
• 22 Duron JJ, Silva NJ, du Montcel ST, Berger A, Muscari F, Hennet H, Veyrieres M, Hay JM.. Adhesive postoperative small bowel obstruction: incidence and risk factors of recurrence after surgical treatment: a multicenter prospective study. Ann Surg 2006; 244: 750-7 DOI: 10.1097/01.sla.0000225097.60142.68.. PubMed PMID: 17060768; PMCID: PMC1856591.
  CrossrefPubMedGoogle Scholar
• 23 Choi JH, Song SY, Park HS, Kim CH, Kim JY, Lew DH, Roh TS, Lee DW.. Robotic DIEP Flap Harvest through a Totally Extraperitoneal Approach Using a Single-Port Surgical Robotic System. Plast Reconstr Surg 2021; 148: 304-7 DOI: 10.1097/PRS.0000000000008181.. PubMed PMID: 34398082
  CrossrefPubMedGoogle Scholar
• 24 Benjoar MD, Berdah Y, Dubosq F, Zarca D, Lantieri L, Hans S, Hivelin M.. Reply: Minimally Invasive Laparoscopically Dissected Deep Inferior Epigastric Artery Perforator Flap: An Anatomical Feasibility Study and a First Clinical Case. Plast Reconstr Surg 2018; 142: 787e-9e DOI: 10.1097/PRS.0000000000004947.. PubMed PMID: 30512000
  CrossrefPubMedGoogle Scholar