Clinical outcomes following robotic versus conventional DIEP flap in breast reconstruction: A retrospective matched study

Min Jeong Lee; Jongmin Won; Seung Yong Song; Hyung Seok Park; Jee Ye Kim; Hye Jung Shin; Young In Kwon; Dong Won Lee; Na Young Kim

doi:10.3389/fonc.2022.989231

Clinical outcomes following robotic versus conventional DIEP flap in breast reconstruction: A retrospective matched study

Front Oncol. 2022 Sep 14:12:989231. doi: 10.3389/fonc.2022.989231. eCollection 2022.

Authors

Min Jeong Lee¹, Jongmin Won², Seung Yong Song², Hyung Seok Park³, Jee Ye Kim³, Hye Jung Shin⁴, Young In Kwon¹, Dong Won Lee², Na Young Kim¹

Affiliations

¹ Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
² Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea.
³ Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
⁴ Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea.

Abstract

Background: A robotic deep inferior epigastric perforator (DIEP) flap created through a totally extraperitoneal approach minimizes violation of the donor site, which may lead to postoperative pain reduction and rapid recovery. The authors compared the clinical outcomes of robotic and conventional DIEP flap breast reconstructions.

Methods: Data from consecutive patients who underwent mastectomy with DIEP flaps for breast reconstruction between July 2017 and January 2021 were retrospectively reviewed. Patients were divided into robotic and conventional DIEP groups, and the two groups were matched using the inverse probability of treatment weighting method. They were compared based on the reconstruction time, drainage amount, postoperative pain, rescue analgesics, hospital stay, complications, and BREAST-Q scores.

Results: After matching, a dataset of 207 patients was formed, including 21 patients in the robotic DIEP group and 186 patients in the conventional DIEP group. The mean reconstruction time was longer in the robotic DIEP group than in the conventional DIEP group (P<0.001). In the robotic group, pain intensity during the postoperative 6-24 hours was significantly reduced (P=0.001) with less use of fentanyl (P=0.003) compared to the conventional DIEP group. The mean length of hospital stay for the robotic DIEP group was shorter than that for conventional DIEP (P=0.002). BREAST-Q scores indicated a higher level of the abdominal physical well-being domain in the robotic group (P=0.020). Complication rates were comparable between the two groups.

Conclusions: This study suggests that a robotic DIEP flap offers enhanced postoperative recovery, accompanied by a reduction in postoperative pain and hospital stay.

Keywords: breast reconstruction; clinical outcome; conventional DIEP; deep inferior epigastric perforator flap; robot surgery; robotic DIEP.