Robotic Harvest of the Latissimus Dorsi (LD) Muscles

Study Overview
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Brief Summary
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The goal of this clinical research study is to learn more about the safety and feasibility of using the Da Vinci Robotic Surgical system in procedures that harvest the latissimus dorsi muscle (a back muscle below your shoulder) for reconstructive procedures.

Detailed Description
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If participant is found to be eligible to take part in this study, and participant agrees, participant's screening, reconstructive surgery, and follow-up appointments will be scheduled over multiple visits, as listed in this consent form. All procedures will be performed on days in which standard of care procedures would already be performed. If it is determined that participant is eligible, the following will be performed before the surgery: The study doctor or a member of the research team will review participant's medical information and ask participant questions about participant's medical history and demographic information. Participant will have a physical exam. Participant will be evaluated by a Physical Therapist to test participant's range of motion and strength. Participant will complete a questionnaire about pain, as well as participant's shoulder, arm, and hand range of motion. This information will be used to compare with the results after the surgery. This will take about 5 minutes to complete. Photographs and/or videos of the surgical site will be taken. If participant can become pregnant, participant will have a urine pregnancy test. To take part in this study, participant must not be pregnant. Surgery Study Visit (2): At this visit, participant's reconstructive surgery will be performed using a robot, called the Da Vinci® Robotic Surgical System. The reconstructive surgery is considered to be standard of care. Participant will be asked to sign a separate consent form that discusses the possible benefits and risks of the standard of care surgical procedure in more detail, including information about any anesthetic participant will be given for the surgery. A standard muscle harvest procedure takes about 2 hours. A muscle harvest procedure with the robotic system is expected to take longer than the standard surgery. The total procedure time will vary for each patient depending on the type of muscle harvest procedure and other factors in the operating room. The total time to complete the muscle harvest and reconstruction will take about 4 hours. Photographs and/or videos of the surgical site will be taken. Participant will remain in the hospital for 3-4 days after the surgery is complete for observation. After participant is discharged from the hospital, participant will need to return within 2 weeks for participant's first follow-up examination. Follow-Up Study Visits (3-6): After participant has been discharged from the hospital, participant will have 4 follow-up visits. The first follow up visit will take place within two weeks after participant is discharged . The second follow-up visit will be between 2-4 weeks, the third follow up visit will be between 1-3 months and the fourth follow up will be between 3-6 months after participant is discharged. The following tests and procedures will be performed at each follow-up visit: The study doctor will check the surgery site(s). Participant's overall health status will be checked. Participant will be evaluated by a Physical Therapist to test participant's range of motion and strength. Photographs and/or videos of the surgical site may be taken. Participant will complete the questionnaire about pain and participant's shoulder, arm, and hand range of motion. This information will be used to compare with the results from before the surgery. Length of Study Participation: Participation on the study will be over after the follow-up visits. This is an investigational study. The use of the Da Vinci® Robotic Surgical System for surgery in the thorax (part of the upper body) is FDA approved and commercially available at this time. However, the system has not been FDA cleared specifically for use in latissimus dorsi muscle harvest procedures. The use of the DaVinci Robotic Surgical System for this type of reconstructive surgery has not been performed in live humans and is what researchers are investigating for this study. Up to 15 patients will take part in this study. All will be enrolled at MD Anderson.

Official Title
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Pilot Study of Robotic-Assisted Harvest of the Latissimus Dorsi Muscles

Conditions
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Cancer, Other Reconstructive Surgery, Failure of Muscle Graft, Complications, Surgical Procedure, Unspecified

Intervention / Treatment
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* Device: da Vinci® Robotic Surgical System
* Procedure: LD muscle flap harvest procedure
* Procedure: Reconstructive surgery
* Behavioral: Questionnaires


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The subject must be equal to or greater than 18 years of age. The subject must be willing and able to provide informed consent. The subject is willing and able to comply with the study protocol. The subject is undergoing one of the following reconstructive procedures that requires latissimus dorsi muscle harvest: a. Post-mastectomy breast reconstruction procedure (either nipple or skin sparing) in which a female subject needs additional muscle coverage over an implant, but does not need additional skin (i.e., patient is a candidate for a pedicled latissimus dorsi muscle flap procedure); b. Scalp reconstruction procedure in which the subject needs a free latissimus dorsi muscle flap for wound coverage; c. Upper extremity reconstruction procedure in which the subject needs a free latissimus dorsi muscle flap for wound coverage; or, d. Lower extremity reconstruction procedure in which the subject needs a free latissimus dorsi muscle flap for wound coverage. The subject agrees to follow-up examinations out to 6 months post-treatment. Exclusion Criteria: The subject has a BMI > 35. The subject has a history of significant bleeding disorders. The subject is diabetic. The subject is known or suspected to be pregnant or lactating. The subject has a history of peripheral vascular disease. The subject is a current smoker (has smoked within 4 weeks prior to surgery). The subject has had prior back or axillary surgeries which could compromise the blood supply of the flap.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Robotic Harvest of the LD Muscles<br>Surgical harvesting of the Latissimus Dorsi (LD) Muscles using da Vinci® robotic surgical system in participants undergoing LD muscle flap harvest procedures in conjunction with breast, scalp, upper extremity and lower extremity reconstructive surgery procedures. | Device: da Vinci® Robotic Surgical System<br>* Da Vinci Robotic Surgical system to be used in procedures that harvest the latissimus dorsi muscle for reconstructive procedures<br>* Other names: Robotic surgery;Procedure: LD muscle flap harvest procedure<br>* Latissimus dorsi muscle flap harvest procedure using da Vinci® Robotic Surgical System for use in reconstructive surgery.<br>Procedure: Reconstructive surgery<br>* Reconstructive surgery is considered to be standard of care.<br>Behavioral: Questionnaires<br>* Questionnaire about pain, as well as participant's shoulder, arm, and hand range of motion completed at baseline, and at follow up visits 3-6.<br>* Other names: Surveys;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Assessed for Donor Site Complications and Muscle Flap Viability | Muscle flap viability was determined by measuring the blood flow into and out of the muscle flap with a hand held Doppler after muscle harvest was complete | Participants were followed for up to a total of 6 months post-operatively | 
| Number of Participants With LD Muscle Flap Viability Following Robotic-Assisted Harvest Procedure |  | Participants were followed for up to a total of 6 months post-operatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of Donor Site Complications Through 6 Months Post-procedure | The participants listed were evaluated for donor site complication. | Participants were followed for up to a total of 6 months post-operatively | 
| LD Muscle Flap Failure Through 6 Months Post-procedure | Flap failure is defined as irreversible arterial and venous thrombosis detected by implantable or surface doppler signal. | Participants were followed for up to a total of 6 months post-operatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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da Vinci® robotic surgical system, latissimus dorsi muscle flap harvest procedures, breast reconstruction, scalp reconstruction, upper extremity reconstruction, lower extremity reconstruction