Proposal of a New Minimally Invasive Technique for Latissimus Dorsi Muscle Harvest

Objective. To evaluate the feasibility of the latissimus dorsi muscle (LD) harvest assisted by endoscopy and the reduction of surgical times in an animal model.

Material and methods. Three (unilateral) procedures of LD assisted by endoscopy were performed in 3 pigs through a single incision, with the placement of three work ports for the first pig and 2 for the other two, the surgical times were recorded, errors and complications in the technique.

Results. In the first model, the incision measured 10-12 cm and three working ports were placed, according to the traditional dissections described in different articles. In the following two models only 3-4 cm incision was necessary, The surgeon took another position and placed only two working trocars, allowing a better dissection, without the need for a third work port. With the new position of the surgeon and placement of the trocars, the reduction of surgical time was achieved, the first model with a time of 2 hours and 30 minutes, second 2 hours and 05 minutes and finishing the third model with 1 hour and 15 minutes.

Conclusion. In the literature, 88 to 289 minutes are reported for endoscopic LD harvest 1,2. This model is within the published times, managing to reduce the harvest time with the use of only 2 work ports. For the LD endoscopic harvest, especially for immediate reconstruction after mastectomies, a greater learning curve is required, which is why a training model is indispensable, being the porcine model ideal, due to its anatomy comparable to that of humans.3,4

The minimally invasive (LD) dissection can be performed in less time, by placing the surgeon cranial to the model, thus facilitating the dorsal and caudal dissection of the muscle, with this change of position can have greater access to the distal edges of the LD, so that a second incision is no longer necessary and the only incision can be reduced in size compared to traditional techniques where two incisions are made, and the placement of a third work trocar being unnecessary.

This is the initial study for the description of the endoscopy assited technique, to minimize the difficulty of the movement of the endoscopic instruments and to improve the surgical times, which will give way to be able to perform more extensive studies, in order to implement this technique in a way routine in humans.

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2. Menke H, Erkens M, Olbrish RR (2001) Evolving concepts in breast reconstruction with latissimus dorsi flaps: results and follow-up of 121 consecutive patients. Ann Plast Surg 47:107–114
3. Ghetu N, Iliescu VM, Ghetu DE, et al. Endoscopic-assisted harvest of gracilis muscle in pigs. A model to learn and practice endoscopic. Jurnalul de Chirurgie 2010; 6(4): 456-466
4. Millican PG, Poole MD. A pig model for investigation of muscle and myocutaneous flaps. Br J Plast Surg 1985;38(3):364-8.