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CC BY-NC 4.0 · Arch Plast Surg 2022; 49(01): 34-38
DOI: 10.5999/aps.2021.00703
Breast/Trunk
Case Report

Initial report of extraperitoneal pedicle dissection in deep inferior epigastric perforator flap breast reconstruction using the da Vinci SP

Ji Hyuk Jung   
Department of Plastic and Reconstructive Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
,
Yeo Reum Jeon   
Department of Plastic and Reconstructive Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
,
Dong Won Lee 
Institute for Human Tissue Restoration and Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
,
Hyung Seok Park 
Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
,
Dae Hyun Lew 
Institute for Human Tissue Restoration and Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
,
Tae Suk Roh 
Institute for Human Tissue Restoration and Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
,
Seung Yong Song 
Institute for Human Tissue Restoration and Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
› Author Affiliations *The two authors contributed equally to this work.
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The deep inferior epigastric perforator (DIEP) flap has been widely used for autologous breast reconstruction after mastectomy. In the conventional surgical method, a long incision is needed at the anterior fascia of the rectus abdominis muscle to obtain sufficient pedicle length; this may increase the risk of incisional hernia. To shorten the incision, several trials have investigated the use of endoscopic/robotic devices for pedicle harvest; however, making multiple additional incisions for port insertion and operating in the intraperitoneal field were inevitable. Here, we describe the first case, in which a DIEP free flap was successfully made using the da Vinci SP model. Our findings can help surgeons perform operations in smaller fields with a single port in the extraperitoneal space. Moreover, this method is expected to lead to fewer donor-related complications and faster healing.

Keywords

Deep inferior epigastric perforator - Breast - Robot - Pedicle - Dissection

This article was presented as a poster at the 10th R&R Forum on July 24-25, 2020.




Publication History

Received: 29 April 2021

Accepted: 06 November 2021

Article published online:
02 June 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • REFERENCES

  • 1 Futter CM, Weiler-Mithoff E, Hagen S. et al. Do pre-operative abdominal exercises prevent post-operative donor site complications for women undergoing DIEP flap breast reconstruction? A two-centre, prospective randomised controlled trial. Br J Plast Surg 2003; 56: 674-83
    PubMedGoogle Scholar
  • 2 Blondeel N, Vanderstraeten GG, Monstrey SJ. et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg 1997; 50: 322-30
    PubMedGoogle Scholar
  • 3 Gundlapalli VS, Ogunleye AA, Scott K. et al. Robotic-assisted deep inferior epigastric artery perforator flap abdominal harvest for breast reconstruction: a case report. Microsurgery 2018; 38: 702-5
    PubMedGoogle Scholar
  • 4 Hivelin M, Lantieri L. Autologous breast reconstruction by deep inferior epigastric free flap: classic and minimally invasive extraperitoneal approaches. Ann Chir Plast Esthet 2018; 63: 457-72
    PubMedGoogle Scholar
  • 5 Selber JC. The robotic DIEP flap. Plast Reconstr Surg 2020; 145: 340-3
    PubMedGoogle Scholar
  • 6 Kuo WL, Huang JJ, Huang YT. et al. Robot-assisted mastectomy followed by immediate autologous microsurgical free flap reconstruction: techniques and feasibility in three different breast cancer surgical scenarios. Clin Breast Cancer 2020; 20: e1-8
    PubMedGoogle Scholar
  • 7 Chang EI, Chang EI, Soto-Miranda MA. et al. Comprehensive analysis of donor-site morbidity in abdominally based free flap breast reconstruction. Plast Reconstr Surg 2013; 132: 1383-91
    PubMedGoogle Scholar