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The last thing on 64-year-old Art Hill’s mind while hiking Machu Picchu this fall is the microvascular muscle flap on his scalp.
But for Jesse Selber, M.D., assistant professor in the Department of Plastic Surgery, it’s a reminder that robotics may one day improve outcomes in reconstructive plastic surgery.
Hill was diagnosed in March 2011 with melanoma at the peak of his scalp. When surgeons went deeper and wider to remove more surrounding tissue, it was vital to cover the palm-sized area. Not only did Hill want to get back to his family and business in Boerne, Texas, but he also needed radiation treatment.
Hill is among the first patients anywhere — not just MD Anderson — to have portions of his latissmus dorsi (the large muscle under the arm that wraps around to the back) harvested robotically and transplanted microsurgically. Selber, who began offering the technique to carefully selected patients in 2011, has been at the forefront of this emerging field.
Other surgical specialties have been using robotics for some time, but only recently has reconstructive plastic surgery seen the potential, Selber says. He’s been sharing his experience and research with colleagues at MD Anderson and elsewhere at every opportunity.
For Hill, electing to have robotic-assisted plastic surgery meant less scarring and greater mobility. Had Selber used the traditional method to harvest the slashes of muscle and skin, Hill would have had about a 15-inch scar under his arm, an extended recovery time and greater risk for complications. Instead, Hill has a number of small punctures under his left arm and around his rib cage.
The tradeoff, at least for now, is that the tedious harvest can take longer than the traditional method.
Selber also has used the technique for breast reconstructions for about a dozen patients.
“I expect robotic microsurgery to explode in the next 20 years,” he says. “We’ve always used our hands, but it’s time to look at what technology can do to enhance what we use.”