Application of endoscopic and robot technique in breast reconstruction using latissimus dorsi muscle flap_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

FENG Yu ¹ , ZHANG Donglin ¹ , LIANG Faqing ^2,3 ,  LI Jinlong ¹ ,  DU Zhenggui ^2,3

1. Department of General Surgery, The Fourth People’s Hospital of Sichuan Province, Chengdu, 610000, P. R. China;
2. Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Breast Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

LI Jinlong, Email: 578783050@qq.com; DU Zhenggui, Email: docduzg@163.com

Keywords：

Latissimus dorsi muscle; endoscopy; robot; breast reconstruction; review

DOI：

10.7507/1007-4848.202310028

Video：

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Latissimus dorsi muscle flap (LDMF) is an important autogenous tissue for autogenous breast reconstruction after mastectomy. LDMF harvesting using a conventional open method is traumatic, and the scar is obvious. With the application of minimally invasive technology in various surgical fields, endoscopic and robotic technology for breast surgery, especially LDMF breast reconstruction, is also becoming mature. Endoscopic or robotic LDMF breast reconstruction has the advantages of no incision in the back, superior cosmetic effect of back, clear vision of surgical field, and low incidence of postoperative complications. It is a safe and effective method of breast reconstruction.

1.	Adams WP, Lipschitz AH, Ansari M, et al. Functional donor site morbidity following latissimus dorsi muscle flap transfer. Ann Plast Surg, 2004, 53(1): 6-11.
2.	Marín-Gutzke M, Sánchez-Olaso A. Reconstructive surgery in young women with breast cancer. Breast Cancer Res Treat, 2010, 123 Suppl 1: 67-74.
3.	Yang CE, Roh TS, Yun IS, et al. Immediate partial breast reconstruction with endoscopic latissimus dorsi muscle flap harvest. Arch Plast Surg, 2014, 41(5): 513-519.
4.	Sood R, Easow JM, Konopka G, et al. Latissimus dorsi flap in breast reconstruction: Recent innovations in the workhorse flap. Cancer Control, 2018, 25(1): 1073274817744638.
5.	Berthet G, Faure C, Dammacco MA, et al. Tolerance of latissimus dorsi in immediate breast reconstruction without implant to radiotherapy. J Plast Reconstr Aesthet Surg, 2018, 71(1): 15-20.
6.	Winocour S, Tarassoli S, Chu CK, et al. Comparing outcomes of robotically assisted latissimus dorsi harvest to the traditional open approach in breast reconstruction. Plast Reconstr Surg, 2020, 146(6): 1221-1225.
7.	夏有辰, 李比, 陈小迅, 等. 背阔肌肌皮瓣的血管解剖及其临床应用. 解剖学报, 2020, 51(1): 93-97.
8.	Fine NA, Orgill DP, Pribaz JJ. Early clinical experience in endoscopic-assisted muscle flap harvest. Ann Plast Surg, 1994, 33(5): 465-469.
9.	Serra-Renom JM, Serra-Mestre JM, Martinez L, et al. Endoscopic reconstruction of partial mastectomy defects using latissimus dorsi muscle flap without causing scars on the back. Aesthetic Plast Surg, 2013, 37(5): 941-949.
10.	Lee J, Jung JH, Kim WW, et al. Endoscopy-assisted muscle-sparing latissimus dorsi muscle flap harvesting for partial breast reconstruction. BMC Surg, 2020, 20(1): 192.
11.	Chang HP, Fan KL, Song SY, et al. The traditional versus endoscopic-assisted latissimus dorsi harvest in oncoplastic surgery: A long term comparison of breast volume, aesthetics, and donor site outcomes. Asian J Surg, 2020, 43(12): 1165-1171.
12.	Kim DG, Kim JS, Lee JS, et al. The usefulness of endoscopic harvesting of the latissimus dorsi flap for breast reconstruction using a single-port and CO₂ gas insufflation technique. Aesthetic Plast Surg, 2021, 45(6): 2681-2690.
13.	Nakajima H, Fujiwara I, Mizuta N, et al. Clinical outcomes of video-assisted skin-sparing partial mastectomy for breast cancer and immediate reconstruction with latissimus dorsi muscle flap as breast-conserving therapy. World J Surg, 2010, 34(9): 2197-2203.
14.	Blay Aulina L, Cremades Pérez M, Navinés Lopez J, et al. Pneumoendoscopic single port approach to breast cancer. How we do it? Surg Oncol, 2020, 32: 41-45.
15.	Nakajima H, Sakaguchi K, Mizuta N, et al. Video-assisted total glandectomy and immediate reconstruction for breast cancer. Biomed Pharmacother, 2002, 56 Suppl 1: 205s-208s.
16.	Ma JX, Li B, Xia YC, et al. Latissimus dorsi muscle flap transfer through endoscopic approach combined with the implant after tissue expansion for breast reconstruction of mastectomy patients. BMC Surg, 2022, 22(1): 10.
17.	Pomel C, Missana MC, Atallah D, et al. Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. Eur J Surg Oncol, 2003, 29(2): 127-131.
18.	Iglesias M, Gonzalez-Chapa DR. Endoscopic latissimus dorsi muscle flap for breast reconstruction after skin-sparing total mastectomy: Report of 14 cases. Aesthetic Plast Surg, 2013, 37(4): 719-727.
19.	Missana MC, Pomel C. Endoscopic latissimus dorsi flap harvesting. Am J Surg, 2007, 194(2): 164-169.
20.	Xu S, Tang P, Chen X, et al. Novel technique for laparoscopic harvesting of latissimus dorsi flap with prosthesis implantation for breast reconstruction: A preliminary study with 2 case reports. Medicine (Baltimore), 2016, 95(46): e5428.
21.	Akita S, Tokumoto H, Yamaji Y, et al. Scarless donor site for breast reconstruction by endoscopy-assisted extended latissimus dorsi flap plus lipofilling. Plast Reconstr Surg, 2023 May 23.
22.	Ahmed YS, Abd El Maksoud WM. Combined endoscopy-assisted muscle-sparing latissimus dorsi flap harvesting with lipofilling enhancement as a new volume replacement technique in breast reconstruction. Breast J, 2022, 2022: 7740439.
23.	Liang F, Wen N, Xie Y, et al. Subversion of endoscopic breast reconstruction surgery: Nipple-sparing mastectomy and immediate reconstruction with a latissimus dorsi flap/latissimus dorsi flap and implant through a single axillary incision. Ann Surg Open, 2021, 2(3): e082.
24.	Feng Y, Wen N, Liang F, et al. Endoscopic nipple- or skin-sparing mastectomy and immediate breast reconstruction with endoscopic harvesting of the latissimus dorsi flap: A preliminary experience of an innovative technique. Breast J, 2022, 2022: 1373899.
25.	吕青. 置身事内: 华西乳腺(癌)腔镜手术的开创与发展创新. 中国普外基础与临床杂志, 2022, 29(11): 1405-1414.
26.	Qiu J, Wen N, Xie Y, et al. Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: A retrospective cohort study of comparing endoscopic and open surgery. Gland Surg, 2022, 11(8): 1383-1394.
27.	Martinez-Ferro M, Fraire C, Saldaña L, et al. Complete videoendoscopic harvest and transposition of latissimus dorsi muscle for the treatment of Poland syndrome: A first report. J Laparoendosc Adv Surg Tech A, 2007, 17(1): 108-113.
28.	Liu C, Luan J, Ouyang Y, et al. Breast reconstruction in Poland syndrome patients with latissimus dorsi myo flap and implant: An efficient endoscopic approach using single transverse axillary incision. Aesthetic Plast Surg, 2019, 43(5): 1186-1194.
29.	Ouyang Y, Xu B, Luan J, et al. Chest wall reconstruction in male Poland syndrome patients with endoscopic-assisted latissimus dorsi muscle flap transfer. J Plast Reconstr Aesthet Surg, 2021, 74(11): 3141-3149.
30.	Selber JC, Baumann DP, Holsinger CF. Robotic harvest of the latissimus dorsi muscle: Laboratory and clinical experience. J Reconstr Microsurg, 2012, 28(7): 457-464.
31.	Selber JC, Baumann DP, Holsinger FC. Robotic latissimus dorsi muscle harvest: A case series. Plast Reconstr Surg, 2012, 129(6): 1305-1312.
32.	Clemens MW, Kronowitz S, Selber JC. Robotic-assisted latissimus dorsi harvest in delayed-immediate breast reconstruction. Semin Plast Surg, 2014, 28(1): 20-25.
33.	Chung JH, You HJ, Kim HS, et al. A novel technique for robot assisted latissimus dorsi flap harvest. J Plast Reconstr Aesthet Surg, 2015, 68(7): 966-972.
34.	Lai HW, Chen ST, Lin SL, et al. Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer: A case report. Medicine (Baltimore), 2018, 97(27): e11373.
35.	Lai HW, Lin SL, Chen ST, et al. Robotic nipple sparing mastectomy and immediate breast reconstruction with robotic latissimus dorsi flap harvest—Technique and preliminary results. J Plast Reconstr Aesthet Surg, 2018, 71(10): e59-e61.
36.	Houvenaeghel G, Cohen M, Ribeiro SR, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with robotic latissimus dorsi flap harvest: Technique and results. Surg Innov, 2020, 27(5): 481-491.
37.	Houvenaeghel G, Bannier M, Rua S, et al. Skin sparing mastectomy and robotic latissimus dorsi-flap reconstruction through a single incision. World J Surg Oncol, 2019, 17(1): 176.
38.	Houvenaeghel G, El Hajj H, Schmitt A, et al. Robotic-assisted skin sparing mastectomy and immediate reconstruction using latissimus dorsi flap a new effective and safe technique: A comparative study. Surg Oncol, 2020, 35: 406-411.
39.	Eo PS, Kim H, Lee JS, et al. Robot-assisted latissimus dorsi flap harvest for partial breast reconstruction: Comparison with endoscopic and conventional approaches. Aesthet Surg J, 2023, 44(1): 38-46.

1. Adams WP, Lipschitz AH, Ansari M, et al. Functional donor site morbidity following latissimus dorsi muscle flap transfer. Ann Plast Surg, 2004, 53(1): 6-11.
2. Marín-Gutzke M, Sánchez-Olaso A. Reconstructive surgery in young women with breast cancer. Breast Cancer Res Treat, 2010, 123 Suppl 1: 67-74.
3. Yang CE, Roh TS, Yun IS, et al. Immediate partial breast reconstruction with endoscopic latissimus dorsi muscle flap harvest. Arch Plast Surg, 2014, 41(5): 513-519.
4. Sood R, Easow JM, Konopka G, et al. Latissimus dorsi flap in breast reconstruction: Recent innovations in the workhorse flap. Cancer Control, 2018, 25(1): 1073274817744638.
5. Berthet G, Faure C, Dammacco MA, et al. Tolerance of latissimus dorsi in immediate breast reconstruction without implant to radiotherapy. J Plast Reconstr Aesthet Surg, 2018, 71(1): 15-20.
6. Winocour S, Tarassoli S, Chu CK, et al. Comparing outcomes of robotically assisted latissimus dorsi harvest to the traditional open approach in breast reconstruction. Plast Reconstr Surg, 2020, 146(6): 1221-1225.
7. 夏有辰, 李比, 陈小迅, 等. 背阔肌肌皮瓣的血管解剖及其临床应用. 解剖学报, 2020, 51(1): 93-97.
8. Fine NA, Orgill DP, Pribaz JJ. Early clinical experience in endoscopic-assisted muscle flap harvest. Ann Plast Surg, 1994, 33(5): 465-469.
9. Serra-Renom JM, Serra-Mestre JM, Martinez L, et al. Endoscopic reconstruction of partial mastectomy defects using latissimus dorsi muscle flap without causing scars on the back. Aesthetic Plast Surg, 2013, 37(5): 941-949.
10. Lee J, Jung JH, Kim WW, et al. Endoscopy-assisted muscle-sparing latissimus dorsi muscle flap harvesting for partial breast reconstruction. BMC Surg, 2020, 20(1): 192.
11. Chang HP, Fan KL, Song SY, et al. The traditional versus endoscopic-assisted latissimus dorsi harvest in oncoplastic surgery: A long term comparison of breast volume, aesthetics, and donor site outcomes. Asian J Surg, 2020, 43(12): 1165-1171.
12. Kim DG, Kim JS, Lee JS, et al. The usefulness of endoscopic harvesting of the latissimus dorsi flap for breast reconstruction using a single-port and CO₂ gas insufflation technique. Aesthetic Plast Surg, 2021, 45(6): 2681-2690.
13. Nakajima H, Fujiwara I, Mizuta N, et al. Clinical outcomes of video-assisted skin-sparing partial mastectomy for breast cancer and immediate reconstruction with latissimus dorsi muscle flap as breast-conserving therapy. World J Surg, 2010, 34(9): 2197-2203.
14. Blay Aulina L, Cremades Pérez M, Navinés Lopez J, et al. Pneumoendoscopic single port approach to breast cancer. How we do it? Surg Oncol, 2020, 32: 41-45.
15. Nakajima H, Sakaguchi K, Mizuta N, et al. Video-assisted total glandectomy and immediate reconstruction for breast cancer. Biomed Pharmacother, 2002, 56 Suppl 1: 205s-208s.
16. Ma JX, Li B, Xia YC, et al. Latissimus dorsi muscle flap transfer through endoscopic approach combined with the implant after tissue expansion for breast reconstruction of mastectomy patients. BMC Surg, 2022, 22(1): 10.
17. Pomel C, Missana MC, Atallah D, et al. Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy. Eur J Surg Oncol, 2003, 29(2): 127-131.
18. Iglesias M, Gonzalez-Chapa DR. Endoscopic latissimus dorsi muscle flap for breast reconstruction after skin-sparing total mastectomy: Report of 14 cases. Aesthetic Plast Surg, 2013, 37(4): 719-727.
19. Missana MC, Pomel C. Endoscopic latissimus dorsi flap harvesting. Am J Surg, 2007, 194(2): 164-169.
20. Xu S, Tang P, Chen X, et al. Novel technique for laparoscopic harvesting of latissimus dorsi flap with prosthesis implantation for breast reconstruction: A preliminary study with 2 case reports. Medicine (Baltimore), 2016, 95(46): e5428.
21. Akita S, Tokumoto H, Yamaji Y, et al. Scarless donor site for breast reconstruction by endoscopy-assisted extended latissimus dorsi flap plus lipofilling. Plast Reconstr Surg, 2023 May 23.
22. Ahmed YS, Abd El Maksoud WM. Combined endoscopy-assisted muscle-sparing latissimus dorsi flap harvesting with lipofilling enhancement as a new volume replacement technique in breast reconstruction. Breast J, 2022, 2022: 7740439.
23. Liang F, Wen N, Xie Y, et al. Subversion of endoscopic breast reconstruction surgery: Nipple-sparing mastectomy and immediate reconstruction with a latissimus dorsi flap/latissimus dorsi flap and implant through a single axillary incision. Ann Surg Open, 2021, 2(3): e082.
24. Feng Y, Wen N, Liang F, et al. Endoscopic nipple- or skin-sparing mastectomy and immediate breast reconstruction with endoscopic harvesting of the latissimus dorsi flap: A preliminary experience of an innovative technique. Breast J, 2022, 2022: 1373899.
25. 吕青. 置身事内: 华西乳腺(癌)腔镜手术的开创与发展创新. 中国普外基础与临床杂志, 2022, 29(11): 1405-1414.
26. Qiu J, Wen N, Xie Y, et al. Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: A retrospective cohort study of comparing endoscopic and open surgery. Gland Surg, 2022, 11(8): 1383-1394.
27. Martinez-Ferro M, Fraire C, Saldaña L, et al. Complete videoendoscopic harvest and transposition of latissimus dorsi muscle for the treatment of Poland syndrome: A first report. J Laparoendosc Adv Surg Tech A, 2007, 17(1): 108-113.
28. Liu C, Luan J, Ouyang Y, et al. Breast reconstruction in Poland syndrome patients with latissimus dorsi myo flap and implant: An efficient endoscopic approach using single transverse axillary incision. Aesthetic Plast Surg, 2019, 43(5): 1186-1194.
29. Ouyang Y, Xu B, Luan J, et al. Chest wall reconstruction in male Poland syndrome patients with endoscopic-assisted latissimus dorsi muscle flap transfer. J Plast Reconstr Aesthet Surg, 2021, 74(11): 3141-3149.
30. Selber JC, Baumann DP, Holsinger CF. Robotic harvest of the latissimus dorsi muscle: Laboratory and clinical experience. J Reconstr Microsurg, 2012, 28(7): 457-464.
31. Selber JC, Baumann DP, Holsinger FC. Robotic latissimus dorsi muscle harvest: A case series. Plast Reconstr Surg, 2012, 129(6): 1305-1312.
32. Clemens MW, Kronowitz S, Selber JC. Robotic-assisted latissimus dorsi harvest in delayed-immediate breast reconstruction. Semin Plast Surg, 2014, 28(1): 20-25.
33. Chung JH, You HJ, Kim HS, et al. A novel technique for robot assisted latissimus dorsi flap harvest. J Plast Reconstr Aesthet Surg, 2015, 68(7): 966-972.
34. Lai HW, Chen ST, Lin SL, et al. Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer: A case report. Medicine (Baltimore), 2018, 97(27): e11373.
35. Lai HW, Lin SL, Chen ST, et al. Robotic nipple sparing mastectomy and immediate breast reconstruction with robotic latissimus dorsi flap harvest—Technique and preliminary results. J Plast Reconstr Aesthet Surg, 2018, 71(10): e59-e61.
36. Houvenaeghel G, Cohen M, Ribeiro SR, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with robotic latissimus dorsi flap harvest: Technique and results. Surg Innov, 2020, 27(5): 481-491.
37. Houvenaeghel G, Bannier M, Rua S, et al. Skin sparing mastectomy and robotic latissimus dorsi-flap reconstruction through a single incision. World J Surg Oncol, 2019, 17(1): 176.
38. Houvenaeghel G, El Hajj H, Schmitt A, et al. Robotic-assisted skin sparing mastectomy and immediate reconstruction using latissimus dorsi flap a new effective and safe technique: A comparative study. Surg Oncol, 2020, 35: 406-411.
39. Eo PS, Kim H, Lee JS, et al. Robot-assisted latissimus dorsi flap harvest for partial breast reconstruction: Comparison with endoscopic and conventional approaches. Aesthet Surg J, 2023, 44(1): 38-46.

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