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Robotic Rectus Muscle Flap for Reconstruction in the Pelvis

  • Shawna R. Kleban
  • Joshua J. Goldman
  • Richard C. BaynosaEmail author
Chapter
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Abstract

Robotic surgery has gained widespread use in several surgical specialties when working in the deep pelvis. The improved visualization, ability to use multiple arms, and precise maneuverability have made the robot increasingly valuable for surgery in this area. With this increased use, plastic surgeons are challenged to reconstruct defects after robotic pelvic tumor extirpation, abdominoperineal resection, and rectovaginal/colovesicular fistula takedown. These patients often have a history of pelvic irradiation, and primary closure is associated with increased rates of wound complications and fistula recurrence. In these cases, reconstruction of the defect with a muscle flap can significantly improve healing and decrease the risk of major complications by bringing in well-vascularized tissue to fill the defect and/or bolster the repair. Given that these procedures are now being performed robotically, plastic surgeons have adopted robotic surgery for a minimally invasive approach to muscle flap harvest. This chapter presents the novel technique of robotically harvesting the rectus abdominis muscle flap from an intraperitoneal approach to reconstruct these defects. The technique, recommended postoperative care, and potential complications are described.

Keywords

Pelvic reconstruction Perineal reconstruction Rectus abdominis Muscle flap Robotic reconstruction Robotic rectus Abdominoperineal resection 
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Supplementary material

Video 14.1

Isolation of the pedicle (MP4 16338 kb)

Video 14.2

Identification of the lateral border of the rectus muscle, dissection to the costal margin (MP4 28505 kb)

Video 14.3

Identification of the medial border of the rectus muscle, dissection to the costal margin (MP4 28783 kb)

Video 14.4

Anterior rectus sheath dissection from muscle (MP4 18886 kb)

Video 14.5

Distal muscle division (MP4 23990 kb)

Video 14.6

Muscle dissection from distal to proximal (MP4 13024 kb)

Video 14.7

Rectus muscle isolation and placement in rectal vault (MP4 46908 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Shawna R. Kleban
    • 1
  • Joshua J. Goldman
    • 1
  • Richard C. Baynosa
    • 1
    Email author
  1. 1.Department of Plastic SurgeryUniversity of Nevada, Las Vegas School of MedicineLas VegasUSA

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