Robot-assisted latissimus dorsi flap harvest for breast reconstruction: a minimally invasive reconstructive surgery

The latissimus dorsi (LD) musculocutaneous flap remains a reliable option in autologous breast reconstruction, especially in patients with compromised soft tissue or prior reconstruction failures. Traditional open harvest, however, carries significant donor-site morbidity, prompting exploration of minimally invasive approaches. Robotic-assisted LD flap harvest has emerged as a promising alternative, offering enhanced visualization and precision with smaller incisions. We present two cases of robotic-assisted LD flap harvest using the da Vinci Xi platform with CO₂ insufflation. Both patients underwent reconstruction with simultaneous tissue expander placement: one following failed autologous-implant hybrid reconstruction, and the other for secondary reconstruction after cosmetic implant complications. A standardized robotic technique was employed, involving three to four robotic ports, CO₂ insufflation at 15 mmHg, and meticulous dissection of the LD muscle with flap delivery through a small axillary incision. Both procedures were completed without intraoperative complications. Patients were discharged on postoperative day one and recovered uneventfully. No donor-site complications were observed, and both patients underwent successful expander-to-implant exchanges. Subjective outcomes were highly favorable, with patients expressing satisfaction with donor-site appearance and breast contour. Compared to traditional open harvest, the robotic approach minimized visible scarring and reduced postoperative morbidity. Robotic-assisted LD flap harvest is a feasible and safe alternative to the open technique, offering technical advantages and improved cosmetic outcomes. While early clinical experience supports its utility, broader adoption will require further studies to validate its reproducibility, long-term safety, and cost-effectiveness. These cases add to the growing evidence supporting the integration of robotics in reconstructive breast surgery, especially in patients seeking optimal outcomes with minimal donor-site morbidity.