Background: The latissimus dorsi muscle is a workhorse of reconstructive surgery. Traditional harvest technique requires a long, posterior donor-site incision. Endoscopic harvest is limited by technical challenges. Robotic technology permits a simpler, minimally invasive harvest technique.
Methods: Seven consecutive robotic latissimus dorsi muscle harvests were performed by a single surgeon. Two were used as free flaps for scalp reconstruction and the remaining five as pedicled flaps for breast reconstruction; three were for immediate, implant-based reconstruction with nipple-areola complex–sparing mastectomies, and two were for radiated breasts when the expander was exchanged for an implant. Harvest technique employed a short, axillary incision for pedicle dissection and two to three additional ports for robotic instrumentation.
Results: All seven muscle flaps were harvested without converting to an open technique. Both free flaps were successfully transferred. All pedicled flaps resulted in successful breast reconstructions. Flap harvest complications included a single, temporary radial nerve palsy in the contralateral extremity, likely from positioning. There were no donor-site hematomas, seromas, or cutaneous thermal injuries. Robotic harvest time decreased from over 2 hours to about an hour over the study period.
Conclusions: Robotic harvest of the latissimus dorsi is a novel and effective method of muscle harvest. It offers technical advantages over endoscopic harvest and aesthetic advantages over the open technique.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
From the Departments of Plastic Surgery and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center.
Received for publication November 15, 2011; accepted January 3, 2012.
Disclosure: Dr. Holsinger was but is no longer a “proctor” for Intuitive Surgical, Inc. (Sunnyvale, Calif.), maker of the da Vinci surgical robot. Drs. Baumann and Selber have no financial interest in any of the products or devices mentioned in this article.
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Jesse C. Selber, M.D., M.P.H.; Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler Street, Unit 41488, Houston, Texas 77030, firstname.lastname@example.org