OncoLog, Volume 58, Number 5, May 2013 Page: 2
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Robotic Surgery and Breast Reconstruction
[Continued from page 1]large and visible scar, the tightness of
the skin around the scar can be painful
and can limit mobility.
To address these issues, Jesse C.
Selber, M.D., an assistant professor in
the Department of Plastic Surgery at
The University of Texas MD Anderson
Cancer Center, developed a robotic sur-
gical procedure for latissimus dorsi mus-
cle harvest that does not leave the con-
spicuous scars associated with the tradi-
tional technique. "It didn't make sense
that plastic surgeons-who should be
the most concerned of any specialists
about aesthetic outcomes-did not have
tools to minimize the invasiveness of
the procedures we do," he said.
The robotic procedure
Dr. Selber's robotic procedure in-
volves making an incision of about 5 cm
in the axilla. If the patient had a senti-
nel lymph node biopsy, the biopsy inci-
sion site can be reused to avoid creating
any additional incisions and scarring.
Robotic arms are inserted into the
patient through three ports. The first
port is placed at the lower end of the
axillary incision, and the next two are
placed through smaller incisions made
12-13 cm apart in front of the edge of
the latissimus dorsi muscle. The robot's
endoscopic camera is inserted through
the middle port, which is about 1 cm
wide. The other two ports, which are
both about 8 mm wide, allow the pas-
sage of the robotic arms into the space
where the muscle can be dissected. The
tools used to harvest the flap are a Cad-
iere grasper, monopolar scissors, and an
electrocautery clamp.
The surgeon controls the move-
ments of the robotic arms through a
console several feet from the patient.
The camera feed provides three-dimen-
sional, high-resolution images, enabling
the surgeon to identify and avoid dam-
aging the blood vessels that are neces-
sary for the survival of the latissimus
dorsi muscle. The surgeon uses the elec-
trocautery clamp to minimize bleeding
and dissect through the cobweb-like
thoracolumbar fascia.
When the surgeon has separated
the latissimus dorsi muscle from the sur-
rounding tissue, the pedicled flap isDuring a tissue flap han.est procedure for breast reconstruction, robotic instruments and
an endoscopic camera are inserted through ports placed in three small incisions.Three-dimensional optics facilitate delicate robotic surgical procedures such as the latis-
simus dorsi muscle flap harvest shown here. The robot's dual controls allow one sur-
geon to operate the robotic surgical tools while a second surgeon provides guidance or
points out critical structures using the blue arrows.transferred under the skin from the
back into the breast while remaining
connected to its blood supply at the
pivot point in the axilla.
Advantages and limitations
Dr. Selber has performer this surgery
in breast cancer patients who have had
lateral lumpectomies and nipple-sparingmastectomies as well as in patients with
a tissue expander who were preparing
to receive radiation therapy and needed
protection for the permanent implant.
He has also used the robotic procedure
to harvest latissimus dorsi free flaps in
patients undergoing scalp or extremity
reconstruction.
After performing more than a dozen2 OncoLog * May 2013
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University of Texas M.D. Anderson Cancer Center. OncoLog, Volume 58, Number 5, May 2013, periodical, May 2013; Houston, Texas. (https://texashistory.unt.edu/ark:/67531/metapth639658/m1/2/: accessed April 24, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.