Robotic Rectus Abdominis Muscle Flap following Robotic Extirpative Surgery

• Published in: Plastic and reconstructive surgery (1963) Vol. 148; no. 6; pp. 1377 - 1381
• Main Authors: Asaad, Malke, Pisters, Louis L., Klein, Geraldine T., Adelman, David M., Oates, Scott D., Butler, Charles E., Selber, Jesse C.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-12-2021
• Subjects: Aged; Humans; Male; Middle Aged; Pelvic Neoplasms - surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Rectus Abdominis - transplantation; Reproducibility of Results; Retrospective Studies; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Surgical Flaps - adverse effects; Surgical Flaps - transplantation; Surgical Wound - etiology; Surgical Wound - surgery; Tissue and Organ Harvesting - adverse effects; Tissue and Organ Harvesting - methods; Treatment Outcome
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/PRS.0000000000008592

Vascularized tissue for obliteration of large pelvic dead spaces created by extirpative surgery has been shown to reduce complication rates. As more extensive resections are performed robotically, plastic surgeons have been challenged to reconstruct the resulting defects using a minimally invasive approach. The goal of this study was to report the authors' experience with robotic harvest of the rectus abdominis muscle for reconstruction of pelvic defects. The authors conducted a retrospective case series of patients who underwent robotic flap harvest following robotic extirpative surgery at their institution. Patient demographics, surgical characteristics, and postoperative outcomes were collected. These were compared to a retrospective cohort of patients who underwent open rectus abdominis muscle harvest. The authors identified seven male patients who underwent robotic flap harvest for pelvic reconstruction between 2013 and 2019. Their mean age was 66 ± 6 years and mean body mass index was 31 ± 5 kg/m2. Six patients (86 percent) had a history of radiation therapy and five patients (71 percent) received hormone therapy or chemotherapy. Surgical-site complications occurred in two patients. One patient developed ventral hernia. The donor-site complication rate was 19 percent (n = 18) in patients who underwent open rectus abdominis muscle harvest (n = 95). This study demonstrates the safety, efficacy, and reproducibility of robotic harvest of the rectus abdominis muscle in complex, multidisciplinary, minimally invasive pelvic surgery. The technique avoids violation of the anterior rectus sheath and wound complications related to open flap harvest, and early experience suggests reduced donor-site morbidity.
Therapeutic, IV.