A Case Series of Robotic-Assisted Rectus Abdominis Flap Harvest for Pelvic Reconstruction: A Single Institution Experience.

STUDY OBJECTIVE: To analyze outcomes and post-operative complications in patients undergoing robotic-assisted rectus abdominis flap harvest for pelvic floor reconstruction.

DESIGN: Case Series SETTING: Academic Setting PATIENTS: Pelvic Reconstruction Surgery Patients INTERVENTIONS: The rectus abdominis muscle flap can be used as a flap for pelvic reconstruction, providing a large volume of soft tissue that can be used in treatment of many comorbid conditions including genital fistulas, post-radiation pelvic exenteration and abdominoperineal resection defects. Intraperitoneal harvest of the rectus muscle using a robotic approach allows avoidance of laparotomy and subsequent disruption of the anterior rectus sheath, thus preserving the integrity of the abdominal wall.

MEASUREMENTS: Retrospective analysis of patient demographic and clinical characteristics was performed of all patients who underwent robotic-assisted rectus abdominis harvest for pelvic floor reconstruction at our institution from October 1, 2016 - October 31, 2018. Post-operative complications analyzed included bowel obstructions, surgical site infections, emergency room visits and need for readmission.

MAIN RESULTS: A total of 6 patients (4female, 2male) with a mean age of 69.2 years (range=57-79) and median follow-up time of 9.2 months (range=5-12). Muscle flap harvest was performed on the right side in 4 patients and on the left in 2 patients. Indications for reconstructive surgery included: vesicovaginal fistula, complex pelvic organ prolapse, anterior and posterior exenteration, partial and total vaginectomy, partial vulvectomy, and abdominoperineal resection. Two patients received neoadjuvant chemoradiation. One out of 6 cases was converted to laparotomy however this was not due to the rectus harvest. Three patients experienced no complications following reconstruction; one patient reported occasional abdominal pain; one patient had intermittent bowel obstruction; and one patient developed a pelvic abscess requiring readmission. All 6 patients achieved satisfactory healing of pelvic wound following robotic-assisted rectus abdominis flap inset.

CONCLUSION: Robotic-assisted rectus abdominis flap harvest for pelvic floor reconstruction is a reliable means of defect closure, despite the presence of substantial comorbidities and risk factors in this patient cohort. Patient selection and counseling is crucial to optimize surgical outcomes in this complex population.