Robotic-Assisted Latissimus Dorsi Flap Harvesting for Delayed Breast Reconstruction ── A Report of Two Cases

以達文西機器手臂取闊背肌皮瓣進行乳房重建手術－病例報告

廖偉捷(Wei-Chieh Liao) ； 黃其晟(Chi-Cheng Huang) ； 蔡明霖(Ming-Lin Tsai) ； 李建智(Jian-Jr Lee)

《臺灣整形外科醫學會雜誌》 25卷4期 (2016/12) Pp. 358-368

摘要

Background: There are two major categories of breast reconstruction, prosthetic reconstruction and autologous tissue reconstruction. Compared with prosthetic reconstruction, autologous tissue reconstruction has the benefit of superior biocompatibility, but the limited tissue source, operative scar, and herniation make it an inferior method. A minimally invasive technique for breast reconstruction with or without prosthesis has the benefit of biocompatibility and very few surgical complications. Aim and Objectives: Robotic-assisted latissimus dorsi (LD) muscle flap breast reconstruction has technical superiority over endoscopic LD flap reconstruction. Compared to the open method, it has a superior cosmetic advantage. Here, we used a trans-axillary gasless technique with an articulated long retractor to enhance robotic flap harvesting. Materials and Methods: We present two cases of breast cancer after tissue expander implantation with a robotic-assisted LD muscle flap for breast reconstruction performed by a single surgeon. A short axillary incision for pedicle dissection and two additional ports for robotic instruments were created during flap harvesting. Results: The mean docking time was 42.5 min, and the total operative time and robotic time were 575 min and 350 min, respectively. Both LD flaps were harvested and transferred successfully without converting to open methods, and both achieved satisfactory results. The drawbacks are prolonged operative time and postoperative seroma formation. The seroma resolved after syringe aspiration performed twice at our outpatient department. Conclusions: Robotic harvesting of the LD muscle flap is a feasible and novel method for breastreconstruction. It offers technical advantages over endoscopic harvesting and esthetic advantages over the open technique.

關鍵字

breast reconstruction ； robotic assisted ； latissimus dorsi flap

並列摘要

背 景：乳房重建手術按照材料來源，大略分為自體組織重建和義乳重建兩個方向。自體組織有相容性高，與原來組織近似的效果，但會有額外大傷口跟手術時間較長的缺點。而利用義乳重建，好處是沒有額外傷口、手術時間也較短，但是組織相容性較低跟衍生的可能併發症、如感染排斥和夾膜攣縮。利用微創手術使用自體組織進行乳房重建，可兼顧組織相容高以及傷口小的優點。目的及目標：以達文西機器手臂取闊背肌皮瓣進行乳房重建手術與使用內視鏡手術比起來，具有技術及視野上的優勢。與傳統開放式取闊背肌皮瓣手術相較之下具有比較美觀傷口的優點。在我們案例當中，我們是利用掛鉤式牽引器進行經腋下無充氣方式來進行機器手臂手術。材料及方法：兩位乳癌患者在接受改良式乳房根除手術後進行組織擴張器的置放，之後由單一整形外科醫師進行達文西機器手臂取闊背肌皮瓣進行乳房重建手術。術中除腋下一個五到六公分的傷口外還有兩個大約一點五公分傷口。結 果：達文西機器手臂器械對接平均時間為42.5 分鐘，機器手臂平均操作時間為350 分鐘，總手術時間平均為575 分鐘。兩位患者的闊背肌皮瓣都成功地由機器手臂取下並且轉移作爲乳房重建。缺點是較長的手術時間以及其中一位患者於術後產生背部皮下積水（組織液）的情形，但是在門診抽除兩次即消除。結 論：以達文西機器手臂取闊背肌皮瓣進行乳房重建手術是一種可行性高及新穎的乳房重建方式，與內視鏡手術比起來具有較高的技術層次，並且在美觀上優於傳統的開放式手術。