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Flaps and Grafts in Robotic Reconstructive Surgery

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Abstract

Purpose of Review

The robotic approach is increasingly popular in reconstructive urology. Reconstructive surgeons have commonly used flaps and grafts for obliterating dead space including tissue interposition or as an alternative to mesh in addressing lower urinary tract dysfunction. Advantages of the robotic approach are less incisional pain, excellent visualization in the deep pelvis, and improved surgeon ergonomics. In this literature review, we describe flaps and grafts used in lower urinary tract robotic reconstructive urology, serving as an almanac for these techniques.

Recent Findings

Omental, peritoneal, vertical rectus abdominis musculocutaneous (VRAM), sigmoid epiploica, gracilis flaps, and Alloderm™ have been reported for tissue interposition during fistula repair. Fascia lata has been described as a mesh alternative for robotic sacrocolpopexy. Besides providing interposition, flaps support native tissue healing and blood supply. Grafts are easy to use with low patient morbidity, but rely on the blood supply at the recipient site.

Summary

Robotic reconstruction is an emerging field, and more studies are needed to define the best uses for each flap and graft as well as strategies to maximize outcomes and minimize morbidity.

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Data Availability

No datasets were generated or analyzed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Urology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 656, Rochester, NY 14610, USA

    Karen M. Doersch

  2. School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA

    Kathleen A. Li

  3. Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Divya Ajay

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  1. Karen M. Doersch
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  3. Divya Ajay
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Contributions

KMD and KAL performed the literature search and reviewed the literature. DA reviewed the literature for completeness. DA provided the images for the figure, which was created by KMD. KMD, KAL, and DA performed the writing and editing of the manuscript. All authors reviewed the manuscript.

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Correspondence to Karen M. Doersch.

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Doersch, K.M., Li, K.A. & Ajay, D. Flaps and Grafts in Robotic Reconstructive Surgery. Curr Urol Rep 25, 109–115 (2024). https://doi.org/10.1007/s11934-024-01201-z

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