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Robotic Versus Conventional Latissimus Dorsi-Flap Harvested for Immediate Breast Reconstruction

Author(s): Houvenaeghel G, Rua S, Barrou J, Troy AV, Knight S, Cohen M, Bannier M

Importance
Latissimus Dorsi-Flap (LDF) is a reliable and reproducible technique for Immediate Breast Reconstruction (IBR) that requires a dorsal scar with the conventional open technique. Robotic-LDF dissection recently described, avoids making a dorsal scar.

Objective
The primary objective of this prospective study was to compare results of R-LDF and conventional LDF (C-LDF) in terms of dorsal complication rate, secondary objectives were to compare length of hospital stay (LHS), length of anesthesia and undertake a cost evaluation.

Design
All patients undergoing LDF-IBR with or without implant reconstruction were analyzed. Complication rate was determined using Clavien-Dindo grading. A cost evaluation was performed. An a priori hypothesis of 100 R-NSM and 100 C-NSM was planned.

Results
204 LDF-IBR were performed, 126 R-LDF (61.8%) and 78 C-LDF, by five surgeons. Several significant differences were reported between the two groups: higher rates of previous radiotherapy, neo-adjuvant chemotherapy (NAC) and NAC with neo-adjuvant radiotherapy in C-LDF group, higher median age and higher rate of nipple sparing mastectomy in R-LDF group. LDF-IBR was associated with implant-IBR in 24.0% of patients (49/204). Duration of surgery was not significantly different for R-LDF versus C-LDF (OR=1.712, 95%CI 0.822-3.566, p=0.151). Crude dorsal complication rate was 35.3% (72/204) including 65 seromas (90.3% complications). There was no significant difference in complication rates between both groups, however Grade 2-3 dorsal complications were associated with LDF with implant reconstruction (OR=5.661, 95%CI 1.146-27.97, p=0.033). A significantly higher cost was observed for R-LDF, with a 27.2% median total cost difference (2108 Euros).

Conclusion
We found no difference between R-LDF and C-LDF, except for a higher cost with R-LDF. Duration of anesthesia and cost decreased significantly over time throughout the learning curve.

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