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Initial Experience With Laparoscopic Inferior Epigastric Vessel Ligation for Delayed Tram Flap Breast Reconstruction
Thadeus L Trus, Dale Collins, Christopher Demas, Carolyn Kerrigan
Dartmouth-Hitchcock Medical Center, Lebanon, NH
Objective: TRAM flap breast reconstruction provides excellent cosmetic results. Pedicle flap viability is greatly enhanced by pre-reconstruction inferior epigastric vessel ligation which encourages collateral arterial flow (Delayed TRAM). We report our initial experience with laparoscopic inferior epigastric vessel ligation.
Design: Prospective case series.
Setting: Tertiary academic referral center.
Patients: Female patients with breast cancer who chose TRAM reconstruction.
Interventions: Vessel ligations are performed 2 weeks prior to TRAM flap reconstruction. The abdomen is accessed through a 2.7 mm umbilical trocar. A 5 mm trocar is placed lateral to the rectus sheath in the right lower quadrant. 5 mm Teflon clips are used to ligate the vessels within 3 cm of their origin. The procedures are performed on an outpatient basis.
Main Outcome Measures: Complications of surgery and subsequent flap viability.
Results: From January 2001 to April 2006, 121 patients had laparoscopic inferior epigastric vessel ligation of which 114 patients had bilateral ligation. Additional laparoscopic procedures in conjunction with vessel ligation were performed in 33 patients (sentinal node biopsy (22), bilateral oophorectomy (7), liver biopsy (2), breast biopsy (1), Nissen fundoplication (1)). Median operative time for those patients undergoing ligation only was 34 minutes (range 14 to 121 minutes). The inferior epigastric vessels could not be identified in two patients. Metastatic breast cancer involving the liver was found in one patient. There were no conversions or complications. Subsequent TRAM flap viability was excellent.
Conclusions: Laparoscopic inferior epigastric vessel ligation for delayed TRAM flap breast reconstruction is a safe, effective procedure.
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