Robotic Harvest of Internal Mammary Vessels in Breast Reconstruction

Abstract

The authors have robotically harvested the internal mammary vessels to provide the recipient pedicle for free-flap breast reconstruction in 22 consecutive cases. Through minimal-access incisions, the robot facilitated the harvest of a pedicle up to 10 cm in length. The pedicle was brought out through the second intercostal space into the mastectomy wound, allowing the anastomosis to be performed on the skin surface with loupes or microscope. This paper illustrates their experience and offers an innovative approach to free-flap breast reconstruction.

Modern adjuncts and technologies in microsurgery: An historical and evidence‐based review

“…The following year Karamanoukian et al56 demonstrated the feasibility of robotic assisted anastomoses in a series in piglets. While not microsurgery per se , the robot has been shown to be useful in dissection of internal mammary arteries both for use as cardiac conduits and as recipient vessels in reconstructive breast surgery 57. Robotics in surgery has evolved fast in other areas of surgery and we identify this area as one needing further research in the field of microsurgery.…”

Plastic and reconstructive robotic microsurgery – a review of current practices

“…The only series reported in the literature details robotic harvest of the (recipient) internal mammary vessels for free tissue breast reconstruction [42]. This technique is certainly aesthetically attractive.…”

“…This technique is certainly aesthetically attractive. However, there was a high complication rate of haematoma, two flap losses, pneumothorax and chest sepsis [42].…”

Robotics in plastic surgery, a review

“…This type of procedure did not prove to be efficient because of a high complication rate. Simple removal of cartilage from the third or fourth rib would expose an adequate vessel for breast reconstruction in a more straight forward manner [41].…”