Robotic surgery has seen rapid and widespread uptake among gynecologic surgeons, largely because of its proven capacity to lower patient morbidity. Plastic surgeons must therefore update their reconstructive strategies to fully leverage the advantages of robotic-assisted procedures. This paper describes our clinical outcomes using robotic-assisted rectus abdominis muscle flaps for posterior vaginal wall reconstruction. It includes a review of the existing literature on robotic-assisted reconstructive pelvic surgery. Following IRB approval, we conducted a retrospective analysis of all patients who received robotic pelvic reconstruction at a single institution from 2016 to 2024. Those who specifically underwent posterior vaginal wall reconstruction with a robotic-assisted rectus abdominis muscle (RRAM) flap were included in the final evaluation.
Thirty-two patients underwent pelvic reconstruction employing robotic surgical methods. Of these, five (mean age = 56.2 years, range = 32–72 years; mean BMI = 30.0, range = 24–39.9) received posterior vaginal wall reconstruction using an RRAM flap. Two patients (40%) experienced minor wound complications, while one patient (20%) developed vaginal stenosis eight years postoperatively. No major complications occurred that required return to the operating room or hospital readmission. All patients ultimately achieved complete and successful healing. Published studies indicate that robotic-assisted surgery offers important benefits, including lower morbidity through reduced intraoperative blood loss, decreased pain, quicker recovery times, and shorter hospital stays. The RRAM flap proves to be well tolerated for pelvic reconstruction even in patients with significant comorbidities, while still preserving the minimally invasive nature of the original extirpative procedure. As robotic technology continues to gain broader acceptance, plastic surgeons should actively incorporate these techniques into their surgical repertoire.
