Rectus Abdominis Pedicled Flap: An Innovative Robotic Approach

Abstract

Video Objective To provide education on the utility of rectus muscle flap during pelvic floor reconstruction and describe in detail a minimally invasive technique to avoid laparotomy. Setting Patients requiring pelvic floor reconstruction at an academic medical center. Interventions The rectus abdominis muscle flap can be used as a workhorse flap for pelvic reconstruction, providing a large volume of well vascularized soft tissue that can be used in treatment of complex pelvic floor reconstruction, 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. This educational video demonstrates robotic docking as well as surgical techniques in detail to show the feasibility for robotic-assisted rectus flap harvest and pelvic floor reconstruction. Conclusion Robotic-assisted rectus abdominis flap harvest for pelvic floor reconstruction is a reliable means of defect closure. This novel approach is surgically feasible for the reconstructive surgeon and maintenance of minimally invasive technique allows for significant advantages over the traditional laparotomy approach.