Comparing Transabdominal and Totally Extraperitoneal Approaches for Minimally Invasive DIEP Flap Harvest: A...

Area of Science:

• Plastic Surgery
• Minimally Invasive Surgery
• Breast Reconstruction

Background:

• Minimally invasive DIEP flap harvest techniques, including TAPP and TEP, aim to reduce morbidity.
• A comparative synthesis of these methods is lacking, hindering consensus on the optimal approach.

Purpose of the Study:

• To synthesize existing literature comparing transabdominal (TAPP) and totally extraperitoneal (TEP) minimally invasive DIEP flap harvest techniques.
• To evaluate operative and clinical outcomes between TAPP and TEP approaches in breast reconstruction.

Main Methods:

• A systematic literature search was conducted following PRISMA guidelines across MEDLINE, Embase, and Cochrane Central.
• Included studies focused on robotic or laparoscopic DIEP flap harvest; cadaveric and non-DIEP studies were excluded.
• A narrative synthesis of pooled data was performed, focusing on operative times, incision lengths, complication rates, pain, and hospital stay.

Main Results:

• Ten studies were included, comparing TAPP and TEP approaches.
• Bilateral TAPP procedures showed longer operative times compared to TEP. TEP resulted in shorter fascial incisions and intramuscular pedicle dissection lengths.
• Overall complication rates, including vessel avulsion, flap loss, infection, and seroma, were similar between TAPP and TEP. Postoperative pain and hospital stay were also comparable.

Conclusions:

• Both TAPP and TEP are safe and effective for minimally invasive DIEP flap harvest.
• TEP may be associated with shorter operative times for bilateral procedures and reduced incision lengths.
• Study heterogeneity and small sample sizes necessitate larger, prospective comparative studies to guide technique selection.