RSS-Feed abonnieren
DOI: 10.1055/s-0032-1315789
Robotic Harvest of the Latissimus Dorsi Muscle: Laboratory and Clinical Experience
Publikationsverlauf
24. Februar 2012
21. März 2012
Publikationsdatum:
28. Juni 2012 (online)
![](https://www.thieme-connect.de/media/jrm/201207/lookinside/thumbnails/10.1055-s-0032-1315789-1.jpg)
Abstract
Minimally invasive harvest of the latissimus dorsi (LD) muscle is a desirable goal because of both the wide utility of this muscle and the length of incision required to harvest it. In this study, robotic harvest of the LD muscle was evaluated in a cadaver model and clinical series. Ten LD flaps were robotically harvested in eight cadavers. Positioning, port placement, procedural steps, instrumentation, and technical obstacles were all critically analyzed and reported. After modifying the technique based on experience gained in the cadaver study, eight LD muscles were robotically harvested and transferred in eight patients. Access included a short axillary incision and two additional port sites along the anterior border of the muscle. Insufflation was used to maintain the optical cavity. Indications included pedicled flaps for implant-based breast reconstruction and free flaps for scalp reconstruction. All flaps were successfully transferred without converting to open technique. In the clinical series, average time for setup and port placement was 23 minutes, and average robotic time was 1 hour and 51 minutes. There were no major complications. Robotic harvest of the LD is feasible and effective and permits full muscle harvest without a visible incision.
-
References
- 1 Yuh BE, Hussain A, Chandrasekhar R , et al. Comparative analysis of global practice patterns in urologic robot-assisted surgery. J Endourol 2010; 24: 1637-1644
- 2 Meehan JJ, Elliott S, Sandler A. The robotic approach to complex hepatobiliary anomalies in children: preliminary report. J Pediatr Surg 2007; 42: 2110-2114
- 3 Jacobsen G, Berger R, Horgan S. The role of robotic surgery in morbid obesity. J Laparoendosc Adv Surg Tech A 2003; 13: 279-283
- 4 Zacharopoulou C, Sananes N, Baulon E, Garbin O, Wattiez A. [Robotic gynecologic surgery: state of the art. Review of the literature]. J Gynecol Obstet Biol Reprod (Paris) 2010; 39: 444-452
- 5 Selber JC. Transoral robotic reconstruction of oropharyngeal defects: a case series. Plast Reconstr Surg 2010; 126: 1978-1987
- 6 Genden EM, Kotz T, Tong CC , et al. Transoral robotic resection and reconstruction for head and neck cancer. Laryngoscope 2011; 121: 1668-1674
- 7 Garfein ES, Greaney Jr PJ, Easterlin B, Schiff B, Smith RV. Transoral robotic reconstructive surgery reconstruction of a tongue base defect with a radial forearm flap. Plast Reconstr Surg 2011; 127: 2352-2354
- 8 Ghanem TA. Transoral robotic-assisted microvascular reconstruction of the oropharynx. Laryngoscope 2011; 121: 580-582
- 9 Genden EM, Park R, Smith C, Kotz T. The role of reconstruction for transoral robotic pharyngectomy and concomitant neck dissection. Arch Otolaryngol Head Neck Surg 2011; 137: 151-156
- 10 Parekattil SJ, Brahmbhatt JV. Robotic approaches for male infertility and chronic orchialgia microsurgery. Curr Opin Urol 2011; 21: 493-499 Review
- 11 Mantovani G, Liverneaux P, Garcia Jr JC, Berner SH, Bednar MS, Mohr CJ. Endoscopic exploration and repair of brachial plexus with telerobotic manipulation: a cadaver trial. J Neurosurg 2011; 115: 659-664
- 12 Harada K, Minakawa Y, Baek Y , et al. Microsurgical skill assessment: toward skill-based surgical robotic control. Conf Proc IEEE Eng Med Biol Soc 2011; 2011: 6700-6703
- 13 Pomel C, Missana MC, Lasser P. [Endoscopic harvesting of the latissimus dorsi flap in breast reconstructive surgery. Feasibility study and review of the literature]. Ann Chir 2002; 127: 337-342 French.
- 14 Lin CH, Wei FC, Levin LS, Chen MC. Donor-site morbidity comparison between endoscopically assisted and traditional harvest of free latissimus dorsi muscle flap. Plast Reconstr Surg 1999; 104: 1070-1077, quiz 1078 Review. Erratum in: Plast Reconstr Surg 2000 Feb;105:823
- 15 Miller MJ, Robb GL. Endoscopic technique for free flap harvesting. Clin Plast Surg 1995; 22: 755-773 Review