Robotic Harvest of the Rectus Abdominis Muscle: A Preclinical Investigation and Case Report

Abstract

In an attempt to decrease donor-site morbidity for rectus abdominis muscle harvest during free tissue transfer, we developed a technique of minimally invasive harvest. The da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) was used in two cadavers for dissection and harvest of four rectus abdominis muscles. After the cadaver dissections were performed, the technique was used in a 30-year-old woman to harvest the left rectus abdominis muscle for free tissue transfer to a lower extremity defect. Four cadaver dissections for harvest of the rectus abdominis muscle using the da Vinci Surgical System were performed. In the cadavers and actual case, three ports (11 mm, 11 mm, and 15 mm) were used to access the abdominal cavity and perform the dissection. An additional 3 cm incision was used to remove the muscle from the abdominal cavity. The patient has not developed any surgical-site morbidity, including bulge or hernia in the 6 months postprocedure. Minimally invasive harvest of the rectus abdominis muscle is possible with the assistance of the da Vinci Surgical System. Potential benefits may include decreased surgical-site morbidity. Also, this may provide an approach to minimally invasive transperitoneal reconstruction.

Keywords

robotic surgery - rectus abdominis harvest - minimally invasive surgery

• References

• 1 Waters JA, Canal DF, Wiebke EA , et al. Robotic distal pancreatectomy: cost effective?. Surgery 2010; 148 (4) 814-823
• 2 Martin AD, Nunez RN, Castle EP. Robot-assisted radical cystectomy versus open radical cystectomy: a complete cost analysis. Urology 2011; 77 (3) 621-625
• 3 Chung JS, Kim WT, Ham WS , et al. Comparison of oncological results, functional outcomes, and complications for transperitoneal versus extraperitoneal robot-assisted radical prostatectomy: a single surgeon's experience. J Endourol 2011; 25 (5) 787-792
• 4 Ascherman JA, Seruya M, Bartsich SA. Abdominal wall morbidity following unilateral and bilateral breast reconstruction with pedicled TRAM flaps: an outcomes analysis of 117 consecutive patients. Plast Reconstr Surg 2008; 121 (1) 1-8
• 5 Suominen S, Asko-Seljavaara S, von Smitten K, Ahovuo J, Sainio P, Alaranta H. Sequelae in the abdominal wall after pedicled or free TRAM flap surgery. Ann Plast Surg 1996; 36 (6) 629-636
• 6 Kroll SS, Schusterman MA, Reece GP, Miller MJ, Robb G, Evans G. Abdominal wall strength, bulging, and hernia after TRAM flap breast reconstruction. Plast Reconstr Surg 1995; 96 (3) 616-619
• 7 Chun YS, Sinha I, Turko A , et al. Comparison of morbidity, functional outcome, and satisfaction following bilateral TRAM versus bilateral DIEP flap breast reconstruction. Plast Reconstr Surg 2010; 126 (4) 1133-1141
• 8 Greensmith A, Januszkiewicz J, Poole G. Rectus abdominis muscle free flap harvest by laparoscopic sheath-sparing technique. Plast Reconstr Surg 2000; 105 (4) 1438-1441
• 9 Venkataramakrishnan V, Southern SJ. Endoscopic rectus harvest: a simplified sheath-saving technique. Ann Plast Surg 1997; 39 (6) 573-577
• 10 Bass LS, Karp NS, Benacquista T, Kasabian AK. Endoscopic harvest of the rectus abdominis free flap: balloon dissection in the fascial plane. Ann Plast Surg 1995; 34 (3) 274-279 ; discussion 279–280
• 11 Lim PC, Kang E, Park H. A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: a case-matched controlled study of the first one hundred twenty two patients. Gynecol Oncol 2011; 120 (3) 413-418
• 12 Chandra V, Nehra D, Parent R , et al. A comparison of laparoscopic and robotic assisted suturing performance by experts and novices. Surgery 2010; 147 (6) 830-839
• 13 Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 1990; 86 (3) 519-526
• 14 Selber JC. Transoral robotic reconstruction of oropharyngeal defects: a case series. Plast Reconstr Surg 2010; 126 (6) 1978-1987