Arch Hand Microsurg.  2020 Jun;25(2):146-150. 10.12790/ahm.20.0006.

Simultaneous Laparoscopic Surgery during Deep Inferior Epigastric Artery Perforator Flap Elevation: A Case Report

• Lee J
• Lee HC
• Lee BI
• Park SH
• Yoon ES

• KMID: 2502712
• DOI: http://doi.org/10.12790/ahm.20.0006

Abstract

As deep inferior epigastric artery perforator (DIEP) flap surgery is gaining popularity, more patients including BRCA-positive patients need simultaneous laparoscopic surgery. We share our experience on a patient who underwent concurrent laparoscopic hysterectomy during flap elevation with a novel method. A patient diagnosed with a right breast cancer also required laparoscopic hysterectomy due to multiple uterine myoma. After perforator mapping was performed, flap elevation through external oblique fascia level was carried out first, sparing the periumbilical perforator and superficial inferior epigastric vein. Three ports were inserted for laparoscopy on posterior fascia level in the periumbilical area, left upper quadrant area and suprapubic area. The surgery was completed without any complication, gas leaks or vascular injury with the advantage of reduced risk of vascular damage and less surgical incision.

Keyword

DIEP; Breast reconstruction; Laparoscopy

Figure

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  Fig. 1. Computed tomographic angiography of the patient. (A) Perforator mapping for deep inferior epigastric artery perforator flap. (B) Multiple uterine myoma with secondary degeneration.

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  Fig. 2. (A) Port placement plan after dissection through external oblique fascia (1, main port for endoscopy; 2, left upper quadrant port; 3, suprapubic port). (B) Dissection until external oblique fascia is reached. (C) Simultaneous laparoscopic surgery after port insertion. (D) Appropriate fascial closure after laparoscopic surgery.

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  Fig. 3. Clinical photo of 45-year-old female patient received simultaneous laparoscopic surgery with deep inferior epigastric artery perforator flap: (A) preoperative, (B) postoperative 6 months, and (C) no additional scarring can be seen 6 months after operation.

Reference

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