by Winocour, Sebastian; Tarassoli, Sam; Chu, Carrie K.; Liu, Jun; Clemens, Mark W.; Selber, Jesse C.
Plastic and
Reconstructive Surgery: December 2020
- Volume 146 - Issue 6 - p 1221-1225
Background:
Robotically assisted latissimus dorsi harvest permits
harvest of the latissimus dorsi muscle without a back incision, as compared to
the traditional open technique. The authors hypothesized that robotic harvest
has lower donor-site complication rates, decreased opioid requirements, and a
shorter length of stay than the traditional open technique.
Methods:
A retrospective review was performed of all consecutive
pedicled latissimus dorsi flaps for breast reconstruction between 2011 and
2015. All procedures were conducted by two surgeons who performed both robotic
and open cases.
Results:
Fifty-two patients were identified; 25 underwent robotically
assisted latissimus dorsi harvest and 27 underwent the open technique.
Demographic data between the two groups were similar. Median length of stay for
robotic harvest was shorter than that for the traditional technique (2 days
versus 3 days; p = 0.031). Postoperative morphine requirement was less in the
robotic compared to the traditional technique, but the difference was not
significant (158 mg versus 184 mg; p = 0.826). Seroma rate was higher in the
robotic group (16 percent versus 0 percent; p = 0.034). The mean duration of
surgery was longer in the robotic cohort (388 minutes versus 311 minutes; p =
0.002).
Conclusions:
This study demonstrates robotically assisted latissimus
dorsi harvest as an effective alternative to the traditional open technique in
select patients. Advantages of robotic harvest include no back scar, a shorter
length of stay, and lower opioid requirements, although the difference was not
significant; disadvantages include longer operative time and a higher seroma
rate. Clinical Question/Level of Evidence: Therapeutic, III.
