Robotic-Assisted Versus Conventional DIEP Flap Breast Reconstruction: A Critical Review of the Current Literature

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Abstract
Background/Objectives: Robotic-assisted breast reconstruction with deep inferior epigastric perforator (DIEP) flap has been developed as a minimally invasive alternative to conventional open DIEP harvest, having the primary goal of reducing donor-site morbidity while preserving flap reliability. Methods: A targeted literature search was performed in PubMed using the keywords “robotic” AND “DIEP”. Following title, abstract and reference screening, 10 studies were included in the final analysis. The current narrative review summarizes the existing literature regarding robotic versus conventional DIEP flap reconstruction, concentrating on abdominal wall preservation, postoperative pain and recovery, operative time, flap survival, and complication rates, with respect to learning curve and feasibility. Results: The included studies demonstrate significantly shorter fascial incisions, together with reduced abdominal wall disruption in robotic DIEP harvest compared with conventional techniques. However, current evidence has not demonstrated that this anatomical difference translates into clinically significant reductions in donor-site morbidity. Some comparative studies also report lower postoperative pain scores and shorter hospital stay in robotic cohorts. Flap survival and overall complication rates appear comparable between robotic and conventional DIEP reconstruction. However, robotic surgery remains linked to longer operative times and higher infrastructural requirements. Conclusions: Robotic DIEP reconstruction represents a feasible and potentially advantageous evolution in autologous breast reconstruction, but larger prospective multicenter studies with long-term follow-up are necessary to establish definitive superiority over conventional techniques.

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