LAUSR

SUMMARY To minimize the donor site damage, robotic-assisted DIEP (RA-DIEP) flap harvest was suggested recently. Present robotic approaches favor port placement which either do not allow a bilateral DIEP flap harvest through the same ports or necessitate additional scars. Herein, we propose a modification of port configuration.In a retrospective controlled cohort study, RA-DIEP and conventional DIEP surgeries were compared. The perforator and pedicle were conventionally visualized until the level behind the rectus abdominis muscle. Next, the robotic system was installed to dissect the retro-muscular pedicle. We assessed patient age, BMI, history of smoking, diabetes mellitus, hypertension, and additional surgical time. The ARS incision length was measured. Pain was quantified by the visual analogue scale. Donor site complications were assessed.Thirteen RA-DIEP flaps (11 unilateral, 2 bilateral) and 87 conventional DIEP flaps were harvested without flap loss. The bilateral DIEP flaps were raised without re-adjustments of the ports. The mean time for pedicle dissection was 53.2 ± 13.4 min. The ARS incision length was significantly shorter in the RA-DIEP group (2.67 ± 1.13 cm vs 8.14 ± 1.69, 304.87 % difference, p < 0.0001). There was no statistical difference in postoperative pain (day 1: 1.9 ± 0.9 vs 2.9 ± 1.6, p = 0.094; day 2: 1.8 ± 1.2 vs 2.3 ± 1.5, p = 0.319; day 3: 1.6 ± 0.9 vs 2.0 ± 1.3, p = 0.444).Preliminary results show that our RA-DIEP approach is safe and allows dissection of bilateral RA-DIEP flaps with short ARS incision length.