Dataset Information

Robotic Transfer of the Latissimus Dorsi Associated With Levator Scapulae and Rhomboid Minor Mini-Open Transfers for Trapezium Palsy.

ABSTRACT: Robotic surgery has been used for a long time. With advantages over traditional surgical methods, it is earning space and expanding use to daily medical practice in several surgical specialties. This Technical Note presents an endoscopic robotic posterior shoulder approach using the DaVinci® robot. It can allow the surgeon to perform latissimus dorsi transfer endoscopically and associate it with levator scapulae and rhomboid minor mini-open transfers to treat accessory nerve lesions with trapezium muscle palsy. This technique is an alternative to Eden-Lange and triple-tendon transfer.

SUBMITTER: Garcia JC

PROVIDER: S-EPMC7695592 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Robotic Transfer of the Latissimus Dorsi Associated With Levator Scapulae and Rhomboid Minor Mini-Open Transfers for Trapezium Palsy.

Garcia Jose Carlos JC Torres Marcelo Cerdan MC Fadel Maurício Salomão MS Bader Diogo D Lutfi Hilton H Kozonara Marcio Eduardo ME

Arthroscopy techniques 20201120 11

Robotic surgery has been used for a long time. With advantages over traditional surgical methods, it is earning space and expanding use to daily medical practice in several surgical specialties. This Technical Note presents an endoscopic robotic posterior shoulder approach using the DaVinci® robot. It can allow the surgeon to perform latissimus dorsi transfer endoscopically and associate it with levator scapulae and rhomboid minor mini-open transfers to treat accessory nerve lesions with trapezi ...[more]

PMID: 33294332

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Project description:BackgroundTendon transfers of the latissimus dorsi transfer (LDT) or the lower trapezius transfer (LTT) are treatment options for irreparable posterosuperior irreparable rotator cuff tears (PSIRCT). There is still no consensus on which type of tendon transfer is superior in the treatment of PSIRCT. Due to the differences in the anatomy and biomechanics, we hypothesize that there are different clinical situations in which either LDT or LTT should be preferred. The aim of this study was to evaluate the clinical and radiological outcomes of LDT and LTT in patients with PSIRCT to establish a clinical algorithm for the treatment decision.Materials and methodsThis is a retrospective, single-center observational study. Included were patients who underwent arthroscopically assisted LDT (aaLDT) or arthroscopically assisted LTT (aaLTT) for PSIRCT. In all patients, range of motion (ROM), external rotation strength, visual analog scale of pain and subjective shoulder value were determined pre- and postoperatively. Constant-Murley score was evaluated at the final follow-up. The complication rate, failure of the tendon transfer, and revision rate were analyzed.ResultsIn total, 29 aaLDT (age 64 years, median follow-up time 45 months) and 8 aaLTT (age 54 years, median follow-up time 34 months) were included. Active ROM, visual analog scale and subjective shoulder value was significantly improved in both cohorts. At follow-up, the median Constant-Murley score was 73 (aaLDT) and 77 (aaLTT), respectively. The failure rate, including revision surgery, was 14% (aaLDT) and 13% (aaLTT), respectively. Low functional findings preoperatively were correlated to a lower functional outcome at follow-up in both groups. Painful loss of anterior elevation and loss of external rotation had no significant impact on functional outcomes in aaLDT.ConclusionFollowing the treatment algorithm based on the clinical examination, clinical outcome parameters, active ROM and pain could be significantly improved. A good preoperative function was associated with a good clinical outcome in both transfers. A low failure and revision rate supports the good decision-making of the algorithm presented.

Project description:BackgroundBreast reconstruction using the latissimus dorsi (LD) flap is one of the most popular and common breast reconstruction techniques among Asian patients. There are increasing numbers of cases wherein breasts need to be reconstructed to moderate to large sizes among the Asian population. Most reconstructive surgeons use abdominal-based flaps-such as the deep inferior epigastric perforator and transverse rectus abdominis myocutaneous flap, or LD flap with an implant-to supplement the volume. Here, we compare the usefulness of the boomerang LD (bLD) flap-a technique developed by modifying the design of the conventional extended LD flap-with that of the LD flap with implant (LDi).MethodsThis was a prospective cohort study including patients with breast cancer aged between 25 and 60 years who underwent unilateral total or skin/nipple-sparing mastectomy, or postmastectomy. The exclusion criteria were advanced breast cancer (stages 3 and 4); a history of cognitive impairment affecting ability to complete the self-reported questionnaire; a history of neurologic or musculoskeletal disorder; and a history of alcohol or drug abuse. Statistical analysis was performed, and correlations between the two technique types were analyzed [including age, body mass index, preoperative breast volume, operation time, flap elevation time, admission duration, adjuvant treatment (radiotherapy, chemotherapy), drain indwelling duration, and drain total sum volume].ResultsIn total, 85 patients who underwent immediate breast construction through the LDi group (n=63) or bLD group (n=25) techniques after total mastectomy between January 2015 and June 2022 were analyzed (mean age: LDi group, 46±7.7 years; bLD group, 45.6±7.8 years). We observed that the flap weight, operative time, mean admission duration, and drain indwelling duration were statistically significantly different in the bLD group (P<0.05). Body mass index, preoperative breast volume, specimen weight, flap elevation time, and drain total time were comparable between groups.ConclusionsBreast reconstruction using the bLD flap was found to be a suitable alternative technique for patients who desire an autologous tissue transfer (rather than an implant) but are contraindicated for abdominal-based flaps and do not mind long postoperative scars.

Dataset Information

Robotic Transfer of the Latissimus Dorsi Associated With Levator Scapulae and Rhomboid Minor Mini-Open Transfers for Trapezium Palsy.

Publications

Robotic Transfer of the Latissimus Dorsi Associated With Levator Scapulae and Rhomboid Minor Mini-Open Transfers for Trapezium Palsy.

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