Robotic Harvest of the Rectus Abdominis Muscle: A Preclinical Investigation and Case Report

In an attempt to decrease donor-site morbidity for rectus abdominis muscle harvest during free tissue transfer, we developed a technique of minimally invasive harvest. The da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) was used in two cadavers for dissection and harvest of four rectus abdominis muscles. After the cadaver dissections were performed, the technique was used in a 30-year-old woman to harvest the left rectus abdominis muscle for free tissue transfer to a lower extremity defect. Four cadaver dissections for harvest of the rectus abdominis muscle using the da Vinci Surgical System were performed. In the cadavers and actual case, three ports (11 mm, 11 mm, and 15 mm) were used to access the abdominal cavity and perform the dissection. An additional 3 cm incision was used to remove the muscle from the abdominal cavity. The patient has not developed any surgical-site morbidity, including bulge or hernia in the 6 months postprocedure. Minimally invasive harvest of the rectus abdominis muscle is possible with the assistance of the da Vinci Surgical System. Potential benefits may include decreased surgical-site morbidity. Also, this may provide an approach to minimally invasive transperitoneal reconstruction.