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Review
. 2023 Jul 27;12(15):4951.
doi: 10.3390/jcm12154951.

The Expanding Utility of Robotic-Assisted Flap Harvest in Autologous Breast Reconstruction: A Systematic Review

Nikita Roy  1 , Christopher J Alessandro  2 , Taylor J Ibelli  1 , Arya A Akhavan  1 , Jake M Sharaf  1 , David Rabinovitch  3 , Peter W Henderson  1 , Alice Yao  1
Affiliations
Review

The Expanding Utility of Robotic-Assisted Flap Harvest in Autologous Breast Reconstruction: A Systematic Review

Nikita Roy et al. J Clin Med. .

Abstract

The expansion of robotic surgery has led to developments in robotic-assisted breast reconstruction techniques. Specifically, robotic flap harvest is being evaluated to help maximize operative reliability and reduce donor site morbidity without compromising flap success. Many publications are feasibility studies or technical descriptions; few cohort analyses exist. This systematic review aims to characterize trends in robotic autologous breast reconstruction and provide a summative analysis of their results. A systematic review was conducted using PubMed, Medline, Scopus, and Web of Science to evaluate robot use in breast reconstruction. Studies dated from 2006 to 2022 were identified and analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Full-text, peer-reviewed, English-language, and human subject studies were included. Non-breast reconstruction articles, commentary, expert opinion, editor's letter, and duplicate studies were excluded. A total of 17 full-text articles were analyzed. The two robotic breast procedures identified were the deep inferior epigastric perforator (DIEP) and the latissimus dorsi (LD) flap. Results showed comparable complication rates and increased operative times compared to NSQIP data on their corresponding open techniques. Additional findings reported in studies included patient reported outcomes, incision lengths, and downward trends in operative time with consecutive procedures. The available data in the literature confirms that robotic surgery is a promising alternative to traditional open methods of breast reconstruction following mastectomy.

Keywords: autologous breast reconstruction; robotic breast surgery; robotic plastic surgery; robotic surgery; robotic-assisted surgery; surgical innovation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol.
Figure 2
Figure 2
Comparison between RABR and NSQIP complication profiles. Key: RABR: Robotic Autologous Breast Reconstruction; NSQIP: National Surgical Quality Improvement Program. *—indicates significance, p < 0.05.
Figure 3
Figure 3
Schematic of port access sites for latissimus dorsi and DIEP flap robotic-assisted surgery. (A) Port site variations for the robotic DIEP. (B) Port site variations for the robotic LD. (C) Depth of port for DIEP-TEP. (D) Depth of port for DIEP-TAPP. Key: DIEP: Deep inferior epigastric perforator; MP: Multi-port; SP: Single-port; TAPP: Transabdominal pre-peritoneal; TEP: Total extraperitoneal.
Figure 4
Figure 4
Mean operative times by reconstruction type. Key: DIEP: Deep inferior epigastric perforator; LD: Latissimus dorsi; NSQIP: National Surgical Quality Improvement Program.
See this image and copyright information in PMC

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