Robotic Harvest of Internal Mammary Vessels in Breast Reconstruction

ABSTRACT

The authors have robotically harvested the internal mammary vessels to provide the recipient pedicle for free-flap breast reconstruction in 22 consecutive cases. Through minimal-access incisions, the robot facilitated the harvest of a pedicle up to 10 cm in length. The pedicle was brought out through the second intercostal space into the mastectomy wound, allowing the anastomosis to be performed on the skin surface with loupes or microscope. This paper illustrates their experience and offers an innovative approach to free-flap breast reconstruction.

KEYWORDS

Breast reconstruction - robotic harvest - internal mammary

REFERENCES

• 1 Meadows M. Robots lend a helping hand to surgeons. FDA Consumer magazine. May-June 2002 36: 5-10
• 2 Okada S, Tanaba Y, Yamauchi H, Sato S. Single-surgeon thoracoscopic surgery with a voice-controlled robot.  Lancet. 1998;  351 1249
• 3 Reichenspurner H, Boehm D H, Gulbins H et al.. Robotically assisted endoscopic coronary artery bypass procedures without cardiopulmonary bypass.  J Thorac Cardiovasc Surg. 1999;  118 960-961
• 4 Boyd W D, Kiaii B, Rayman R, Novick R J, Menkis A H. Totally Endoscopic Coronary Anastomosis: Improving Ease and Accuracy with Robotic Telemanipulation and 3D Visualization. Presented at the International Society for Minimally Invasive Cardiac Surgery (ISMICS) May 19-23, 1999 Paris, France;
• 5 Dupin C L, Allen R J, Glass C A, Bunch R. The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: a report of 110 consecutive cases.  Plast Reconstr Surg.. 1996;  98 685-689
• 6 Feng L J. Recipient vessels in free-flap breast reconstruction: a study of the internal mammary and thoracodorsal vessels.  Plast Reconstr Surg. 1997;  99 405-416
• 7 Serletti J M, Moran S L, Orlando G S, Fox I. Thoracodorsal vessels as recipient vessels for the free TRAM flap in delayed breast reconstruction.  Plast Reconstr Surg. 1999;  104 1649-1655
• 8 Rohrich R J, Copit S, Pittman C E, Robinson J. An anatomic study of the internal mammary veins: clinical implications for free-tissue-transfer breast reconstruction.  Plast Reconstr Surg. 1997;  99 400-404
• 9 Moran S L, Nava G, Behnam A B, Serletti J M. An outcome analysis comparing the thoracodorsal and internal mammary vessels as recipient sites for microvascular breast reconstruction: a prospective study of 100 patients.  Plast Reconstr Surg. 2003;  111 1876-1882
• 10 Nikovic M, Anderl H, Hefel L, Schwabegger A, Wechselberger G. Internal mammary vessels: a reliable recipient system for free flaps in breast reconstruction.  Br J Plast Surg. 1995;  48 533-539
• 11 Nikovic M M, Schwabegger A H, Anderl H. Internal mammary vessels as a recipient site.  Clin Plast Surg. 1998;  25 213-221
• 12 Hamdi M, Blondeel P, Van Landuyt K, Monstrey S. Algorithm in choosing recipient vessels for perforator free flap in breast reconstruction: the role of the internal mammary perforators.  Br J Plast Surg. 2004;  57 258-265
• 13 Schwabegger A H, Ninkovic M M, Moriggl B et al.. Internal mammary veins: classification and surgical use in free-tissue transfer.  J Reconstr Microsurg. 1997;  13 17-23
• 14 Majumder S, Batchelor A G. Internal mammary vessels as recipients for free TRAM breast reconstruction: aesthetic and functional considerations.  Br J Plast Surg. 1999;  52 286-289
• 15 Temple C L, Strom E A, Youssef A, Langstein H N. Choice of recipient vessels in delayed TRAM flap breast reconstruction after radiotherapy.  Plast Reconstr Surg. 2005;  115 105-113