The first robotic DIEP flap harvest was performed in February 2017 at MUSC Health by plastic surgeon Kevin O. Delaney, M.D.,and robotic surgeon Rana C. Pullatt, M.D., who directs the robotic surgery program for the Department of Surgery. DIEP flaps, which have been used to provide living tissue for breast reconstruction for decades, typically require an incision along the entire abdominal wall to provide the surgeon with access to and visualization of the deep inferior epigastric artery and veins. Instead of the 15-cm incision that would have been required for traditional DIEP flap, Delaney was able to make only a 2.5-3.0-cm incision to free the tissue and fat and dissect the portion of the vessels that was accessible from outside the abdominal wall. Seated at a console and with the benefit of high-definition 3D endoscopic visualization of the surgical site, Pullatt then guided the arms of the da Vinci SI robot to dissect the vessels underneath the abdominal fascia from the surrounding tissue until he reached the point where Delaney had stopped. Delaney was then able to lift the flap out with the vessels attached. Although the procedure took a little longer than the traditional surgery, it was much less invasive and resulted in less pain and morbidity for the patient. The technique could prove to be particularly useful in obese patients or those with a great deal of intramuscular mass.
Associate Professor of Surgery
Director of the Robotic Surgery Program in the Department of Surgery
Advanced Laparoscopic Surgery; Bariatric Surgery
Colorectal Surgery; Laparoscopic Hernia Surgery