Robotics muscle harvest
Epublication WebSurg.com, Jul 2014;14(07). URL: http://websurg.com/doi/lt03enselber002
Free and pedicled muscle flaps have been in use by plastic surgeons for a variety of applications since World War I, and remain work horses in scalp, extremity, head, neck and breast reconstruction. Harvest of muscle flaps traditionally requires incisions that allow access to muscle origin, insertion and pedicle. Because some muscles such as the latissimus dorsi and rectus abdominis are large, incisions can be anywhere from 20 to 40 centimeters in length. These donor sites are conspicuously located on the abdomen and back, and are a source of morbidity in the form of cosmesis, seroma and hernia. Because of the desirability of minimally invasive harvest, endoscopic and laparoscopic techniques have been attempted, but have not achieved broad acceptance due to technical challenges related to exposure, retraction and lack of appropriately precise instrumentation. The robotic interface has supplied the necessary exposure and picture clarity through high resolution, three dimensional optics, and the necessary precision instrumentation through wristed motion at the instrument tips to accomplish both muscle and pedicle dissection. For this reason, robotic muscle harvest holds excellent promise in reducing donor site morbidity for these common reconstructive procedures. The author has designed and refined the technique to harvest the latissimus dorsi muscle. This approach involves a short axillary incision, two additional ports and insufflation. The entire muscle can be harvested and brought through the small incision, and has many uses as a free and pedicled flap, including partial breast reconstruction and implant coverage, as well as free flap applications. The rectus abdominis muscle can be harvested through three ports on the contralateral side of the muscle and uses an intraperitoneal approach. The muscle can then be used as a pedicled flap for abdominoperitoneal reconstruction and a free flap for scalp and extremity. Robotic harvest of both of these muscles is safe and effective, and has a significant role to play in the future of reconstructive surgery.