Robotic Transfer of the Latissimus Dorsi.
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ABSTRACT:
SUBMITTER: Garcia JC
PROVIDER: S-EPMC7301275 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:This Technical Note presents an endoscopic robotic anterior axillary shoulder approach using of the DaVinci (Intuitive Surgical, Sunnyvale, CA) robot, which allows one to endoscopically access and harvest the latissimus dorsi tendon for occasions in which the patient presents an irreparable lesion of the subscapularis tendon. Harvesting the latissimus dorsi through an anterior axillary approach is specially desirable when one needs to access the anterior portion of the shoulder, as happens for subscapularis irreparable lesions.
| S-EPMC9244639 | biostudies-literature
Project description:Massive irreparable rotator cuff tears are often associated with severe functional impairment and disabling pain. One viable treatment option is a latissimus dorsi tendon transfer. We propose an all-arthroscopic technique that we believe avoids insult to the deltoid musculature while reducing morbidity from open harvest of the tendon. The operation is performed with the patient in the lateral decubitus position, by use of a combination of viewing and working portals in the axilla. The initial viewing portal is placed along the anterior belly of the latissimus muscle in the axilla. The latissimus and teres major are identified, as is the thoracodorsal neurovascular pedicle. The tendons are carefully separated, and the inferior and superior borders of the latissimus are whipstitched using a suture passer, which helps facilitate subsequent mobilization of the muscle. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the supraspinatus footprint with suture anchors. Our preliminary data suggest that this surgical technique results in improvement in pain, range of motion, and function.
| S-EPMC5021352 | biostudies-literature
Project description:Irreparable tears of the subscapularis (SS) tendon are difficult to manage and represent a challenge for the surgeon, especially in young and active patients. They are associated with a horizontal imbalance of the shoulder, causing pain and limitation of active internal rotation. Historically, the alternative for these patients has been transfer of the pectoralis major, with all its variations, total or partial, up or under the conjoint tendon. However, this transfer has mechanical disadvantages, especially related to the vector of traction, because it originates in the anterior region of the chest. In 2013, Elhassan and colleagues demonstrated in cadavers the technical feasibility and neurological safety of performing transfers of the latissimus dorsi (LD) to the lesser tuberosity to reconstruct irreparable lesions of the subscapularis. This option, compared with alternatives, has superior biomechanical advantages such as a similar vector of traction, originating from lower and posterior to the thorax, in addition to involving a synergistic muscle in action. In early 2016, Kany and colleagues first published a study of 5 patients undergoing arthroscopic assisted LD to SS transfer, with promising results. Our purpose is to present an arthroscopically assisted latissimus dorsi transfer technique in patients with irreparable subscapularis rupture.
| S-EPMC7823060 | biostudies-literature
Project description: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.
| S-EPMC7695592 | biostudies-literature
Project description:For two-stage, implant-based, delayed-immediate reconstruction of the radiated breast, robotic-assisted latissimus dorsi harvest (RALDH) is a good option for patients who wish to avoid a traditional latissimus dorsi donor-site incision. The purpose of this study was to compare outcomes of RALDH and the traditional open technique (TOT) for patients undergoing delayed-immediate breast reconstruction following radiation therapy. A retrospective analysis of a prospective database of all consecutive patients undergoing latissimus dorsi harvest for radiated breast reconstruction between 2009 and 2013 was performed. Indications, surgical technique, complications, and outcomes were assessed. One hundred forty-six pedicled latissimus dorsi muscle flaps were performed for breast reconstruction and 17 were performed robotically during the study period (average follow-up 14.6 ± 7.3 mo). Latissimus dorsi breast reconstruction following radiation was performed in 64 patients using TOT and 12 using RALDH. Surgical complication rates were 37.5% in TOT versus 16.7% in RALDH (p = 0.31) including seroma (8.9% versus 8.3%), infection (14.1 versus 8.3%), delayed wound healing (7.8% versus 0), and capsular contracture (4.7% vs. 0). Robotic-assisted harvest of the latissimus dorsi muscle is associated with a low complication rate and reliable results for delayed reconstruction of the irradiated breast while eliminating the need for a donor-site incision.
| S-EPMC3946018 | biostudies-other
Project description:Irreparable rotator cuff tears remain a surgical problem. The open technique of latissimus dorsi (LD) tendon transfer to "replace" the irreparable rotator cuff is already well known. The aim of this article is to present a modified arthroscopically assisted LD tendon transfer technique. This technique was adopted to operate on patients in the beach-chair position with several improvements in tendon harvesting and fixation. It can be divided into 6 steps, and only 1 step-LD muscle and tendon release-is performed open. The advantages of the arthroscopic procedure are sparing of the deltoid muscle, the possibility of repairing the subscapularis tendon, and the ability to visualize structures at risk while performing tendon harvesting (radial nerve) and passing into the subacromial space (axillary nerve). It is performed in a similar manner to standard rotator cuff surgery-the beach-chair position does not need any modification, and no sophisticated equipment for either the open or arthroscopic part of the procedure is necessary. Nevertheless, this is a challenging procedure and should only be attempted after training, as well as extensive practice.
| S-EPMC4680951 | biostudies-literature
Project description:Robot-assisted surgery is evolving to incorporate a higher number of minimally invasive techniques. There is a growing interest in robotic breast reconstruction that uses autologous tissue. Since a traditional latissimus dorsi (LD) flap leads to a long donor scar, which can be an unpleasant burden to patients, there have been many attempts to decrease the scar length using minimally invasive approaches. This study presents the case of a patient who underwent a robot-assisted nipple-sparing mastectomy followed by immediate breast reconstruction with an LD flap using a single-port robotic surgery system. With the assistance of a single-port robot, a simple docking process using a short and less visible incision is possible. Compared to multiport surgery systems, single-port robots can reduce the possibility of collision between robotic arms and provide a clear view of the medial border of the LD where the curvature of the back restricts the visual field. We recommend the use of single-port robots as a minimally invasive approach for harvesting LD flaps.
| S-EPMC8627951 | biostudies-literature
Project description:Latissimus dorsi tendon ruptures are less-common injuries that can occur in elite throwing athletes. Physical examination of the thrower with a latissimus injury may show ecchymosis of the upper arm and asymmetry of the posterior axillary fold along with possible weakness in shoulder adduction, extension, and internal rotation. Magnetic resonance imaging is used to confirm the diagnosis. Latissimus tendon ruptures are largely treated nonoperatively; surgical repair is only advocated for in professional throwing athletes with complete avulsion injuries or midsubstance latissimus tendon tears. Surgical repair options include the use of suture anchors, cortical suture buttons, or transosseous sutures via a single posterior axillary incision or a 2-incision technique. Given the limited literature on this topic, there have been no studies evaluating the different fixation options or surgical approaches for tendon repair. This article and accompanying video show the technique and discusses the technical pearls of a latissimus tendon repair using suture button fixation via a single-incision approach.
| S-EPMC7029196 | biostudies-literature
Project description:Latissimus dorsi tendon transfer is an effective option for young and active patients with massive irreparable posterosuperior rotator cuff tears and intact subscapularis tendon. This approach has been shown to relieve pain and improve shoulder function in both the short and long term. We describe a surgical technique using an acromial osteotomy to better expose the greater tuberosity for the tendon transfer without disrupting the deltoid muscle. The latissimus dorsi tendon is reinforced with a human dermal collagen matrix (GraftJacket; Wright Medical Group) for additional augmentation of the muscle to gain more excursion for the tendon transfer to the greater tuberosity. The transferred tendon is fixed to the supraspinatus and infraspinatus footprints on the greater tuberosity using suture anchors. The acromial osteotomy is repaired back anatomically with several No. 5 braided sutures (FiberWire; Arthrex).
| S-EPMC5850886 | biostudies-literature
Project description:Latissimus dorsi transfer is a well-established method for the treatment of posterosuperior massive irreparable rotator cuff tears. We propose using an arthroscopically assisted technique that avoids insult to the deltoid. With the patient in the lateral decubitus position, an L-shaped incision is made along the anterior belly of the latissimus muscle and then along the posterior axillary line. The latissimus and teres major are identified and separated. The tendon insertion of the latissimus is isolated, and a FiberWire traction suture (Arthrex, Naples, FL) is placed, facilitating dissection of the muscle to the thoracodorsal neurovascular pedicle and subsequent mobilization. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the lateral aspect of the infraspinatus and supraspinatus footprints by multiple suture anchors.
| S-EPMC3678602 | biostudies-literature