The RoboDIEP: Robotic-Assisted Deep Inferior Epigastric Perforator Flaps for Breast Reconstruction

The deep inferior epigastric perforator (DIEP) flap has been the enduring gold standard in autologous breast reconstruction for the better part of 20 years. Yet in spite of advances in imaging, perfusion technology, and technique, some degree of donor site morbidity remains. Abdominal morbidity is due to extension of the fascial incision and muscular dissection to access the full pedicle. Robotic surgery allows a minimally invasive surgical approach to the pedicle which significantly shortens the fascial incision. The robotic system allows careful vascular dissection with a level of precision and reliability that was not previously available using laparoscopy. Reducing the fascial incision and muscular dissection promises to enhance recovery and reduce short-term pain, long-term hernia, and bulge rate. These enhancements of the DIEP flap may represent a significant improvement over current open techniques where baseline levels of abdominal wall morbidity can still be expected.