A Case Of Robotic Left Internal Mammary Harvest In A Patient Undergoing Maxillo-facial Surgery
John Massey1, Paul Modi2.
1Northern General Hospital, Sheffield, United Kingdom, 2Liverpool Heart and Chest, Liverpool, United Kingdom.
BACKGROUND: The introduction of robotic devices to surgical practice has offered an attractive option for reducing the burden of morbidity associated with maximal access incisions such as median sternotomy. Systematic review of comparative studies comparing coronary artery bypass grafting by sternotomy and robotic coronary artery bypass grafting have shown lower rates of post-operative pneumonia, ventilation time, pain and post-operative stay with minimal access approach. The skills learnt in minimal access cardiac surgery may be used to benefit patients undergoing surgery by other specialties. We present a case of robotic left internal mammary artery harvest in a patient undergoing major maxillo-facial resection and reconstruction. METHODS: N/A
RESULTS: A 44 year old patient was presented to the minimal access cardiac surgical team by the maxillo-facial surgeons. The patient had undergone two major head and neck operative procedures on the floor of the mouth and the mandible for recurrent squamous cell carcinoma of the anterior tongue. Unfortunately, following radiotherapy to the surgical site, the patient developed osteoradionecrosis. Due to the nature of the previous surgery, the left internal mammary artery was planned to be used for the microvascular reconstruction of the jaw. Due to the complexity of the redo-facial surgery, the addition of sternotomy for mammary harvest would have added further burden to the patient, therefore a minimal access approach to the mammary artery was utilised. The surgeon used the Da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) to harvest the left internal mammary artery, the vessel was then tunneled into the neck for use by the maxillo-facial surgeons in reconstructing the jaw. The patient made a full recovery and was discharged home without the added burden of a sternotomy. CONCLUSIONS: In conclusion, we performed robotic internal mammary vessel harvesting using the da Vinci Surgical System safely, with excellent results to aid a patient undergoing major head and neck reconstruction. Robotic assistance provides the advantages of harvesting a longer internal mammary pedicle more safely and quickly with lower morbidity than that associated with a median sternotomy.
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