Robotic Harvest of the Rectus Abdominis Muscle

The rectus abdominis muscle has played a reliable role in the reconstructive armamentarium for decades. When dead space obliteration is required for pelvic reconstruction, the traditional approach when omentum is inadequate is the vertical rectus abdominis myocutaneous flap (VRAM). As many urologic and general surgery procedures have become completely robotic, avoiding the morbidity of a laparotomy, the VRAM becomes the sole purpose of a laparotomy incision. This is both arcane and contradictory to the spirit of the multidisciplinary, minimally invasive approach. The technique of robotic harvest of the rectus muscle has been established, and dead space obliteration in the pelvis can be accomplished with minimal additional morbidity. Robotic harvest of the rectus abdominis is straightforward, reproducible, and effective for a variety of clinical indications both intra-corporally for pelvic reconstruction, as well as extra-corporally as a free flap. To date, robotic-assisted rectus abdominis harvest has been performed successfully in both pelvic and lower extremity reconstruction. This chapter serves to detail the thought process and performance of robot-assisted rectus abdominis harvest, bolstered by case examples and literature review.