The Expanding Utility of Robotic-Assisted Flap Harvest in Autologous Breast Reconstruction: A Systematic Review.

The expansion of robotic surgery has led to developments in robotic-assisted breast reconstruction techniques. Specifically, robotic flap harvest is being evaluated to help maximize operative reliability and reduce donor site morbidity without compromising flap success. Many publications are feasibility studies or technical descriptions; few cohort analyses exist. This systematic review aims to characterize trends in robotic autologous breast reconstruction and provide a summative analysis of their results. A systematic review was conducted using PubMed, Medline, Scopus, and Web of Science to evaluate robot use in breast reconstruction. Studies dated from 2006 to 2022 were identified and analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Full-text, peer-reviewed, English-language, and human subject studies were included. Non-breast reconstruction articles, commentary, expert opinion, editor's letter, and duplicate studies were excluded. A total of 17 full-text articles were analyzed. The two robotic breast procedures identified were the deep inferior epigastric perforator (DIEP) and the latissimus dorsi (LD) flap. Results showed comparable complication rates and increased operative times compared to NSQIP data on their corresponding open techniques. Additional findings reported in studies included patient reported outcomes, incision lengths, and downward trends in operative time with consecutive procedures. The available data in the literature confirms that robotic surgery is a promising alternative to traditional open methods of breast reconstruction following mastectomy.

Use of Tubular Retractor for Resection of Colloid Cysts: Single Surgeon Experience and Review of the Literature.

BACKGROUND: Colloid cysts are challenging lesions to access. Various surgical approaches are utilized which all require brain retraction, creating focal pressure, local trauma, and potentially surgical morbidity. Recently, tubular retractors have been developed that reduce retraction pressure by distributing it radially. Such retractors may be beneficial in colloid cyst resection. OBJECTIVE: To retrospectively review a single neurosurgeon's case series, as well as the literature, to determine the efficacy and safety profile of transtubular colloid cyst resections. We also aim to describe our operative technique for this approach. METHODS: We conducted a retrospective review of colloid cyst resections using either ViewSite Brain Access System (Vycor Medical, Boca Raton, Florida) or BrainPath (NICO, Indianapolis, Indiana) tubular retractors performed by a single neurosurgeon from 2015 to 2017 (n = 10). A literature review was performed to find all published cases of transtubular colloid cyst resections. RESULTS: Gross total resection was achieved in all patients. Early neurologic deficit rate was 10% (n = 1), and permanent neurologic deficit rate was 0%. There were no postoperative seizures or venous injuries. Average hospital stay was 2.0 d. There was no evidence of recurrence at average follow-up length of 13.6 mo. A literature review demonstrated nine studies (n = 77) with an overall complication rate of 7.8%. CONCLUSION: Tubular retractors offer an attractive surgical corridor for colloid cyst resections, avoiding much of the morbidity of interhemispheric approaches, while minimizing damage to normal cortex. There were no permanent complications in our series of ten cases, and a literature review found a similarly benign safety profile.