{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:21:35Z","timestamp":1791598895897,"version":"4.3.4"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T00:00:00Z","timestamp":1766188800000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Minimally invasive techniques for DIEP flap harvest, including transabdominal (TAPP) and totally extraperitoneal (TEP) approaches, have been reported to be beneficial in reducing morbidity; however, direct comparative synthesis between these methods remains scarce, limiting consensus on the optimal approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, we searched MEDLINE, Embase, and Cochrane Central for prospective and retrospective studies on robotic or laparoscopic DIEP harvest in breast reconstruction. Cadaveric studies and non\u2010DIEP procedures were excluded. Primary operative outcomes included harvest time, type of robot, fascial incision length, intramuscular length, and intraoperative complications, while secondary clinical outcomes were postoperative complications, length of stay, and pain. A structured narrative synthesis was conducted using pooled descriptive data, without inferential statistical analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten studies were included, including six describing TAPP harvest, two robotic TEP, and two laparoscopic TEP. Reported unilateral reconstruction times averaged 442.6\u2009\u00b1\u200963.4\u2009min for TAPP and 460.3\u2009\u00b1\u200990.4\u2009min for TEP, while bilateral procedures averaged 682.6\u2009\u00b1\u2009115.1\u2009min for TAPP compared with 453.0\u2009\u00b1\u200981.5\u2009min for TEP. Fascial incisions were longer with TAPP (3.75\u2009\u00b1\u20091.34\u2009cm) compared to TEP (2.59\u2009\u00b1\u20090.49 cm), and intramuscular pedicle dissection length was greater in TAPP (4.1\u2009\u00b1\u20090.7 vs. 2.25\u2009\u00b1\u20090.27\u2009cm). No study reported bowel injury or postoperative ileus, and overall complication rates\u2014including vessel avulsion, flap loss, infection, and seroma\u2014were similar. Postoperative pain scores were 1.9\u2009\u00b1\u20090.9 in TAPP versus 2.3\u2009\u00b1\u20090.9 in TEP, while hospital stay averaged 3.9\u2009\u00b1\u20091.3\u2009days for TAPP and 4.5\u2009\u00b1\u20090.9\u2009days for TEP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both TAPP and TEP appear safe and effective for minimally invasive DIEP flap harvest. Trends suggest bilateral TAPP requires longer operative times, while TEP results in shorter fascial incisions and had shorter intramuscular pedicle lengths. Pain and complication rates were comparable, although study heterogeneity and small sample sizes limit generalizability. Larger, prospective comparative studies are essential to better define technique selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70160","type":"journal-article","created":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T06:14:08Z","timestamp":1766297648000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparing Transabdominal and Totally Extraperitoneal Approaches for Minimally Invasive\n                    <scp>DIEP<\/scp>\n                    Flap Harvest:\u00a0A Systematic Review"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7967-2210","authenticated-orcid":false,"given":"Diwakar","family":"Phuyal","sequence":"first","affiliation":[{"name":"Integrated Surgical Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Gaston","sequence":"additional","affiliation":[{"name":"Integrated Surgical Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Hoffner","sequence":"additional","affiliation":[{"name":"Integrated Surgical Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Darras","sequence":"additional","affiliation":[{"name":"Integrated Surgical Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risal","family":"Djohan","sequence":"additional","affiliation":[{"name":"Integrated Surgical Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Integrated Surgical Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffi","family":"Gurunian","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Cleveland Clinic  Abu Dhabi UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah N.","family":"Bishop","sequence":"additional","affiliation":[{"name":"Integrated Surgical Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,20]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010017\u20105840\u20102"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000004947"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000008988"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000008181"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30856"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31829586a7"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000210679.77449.7d"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30297"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2020.12.044"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000003989"},{"key":"e_1_2_15_13_1","unstructured":"United Nations.2025.\u201cBreast Cancer Cases Projected to Rise by Nearly 40% by 2050.\u201dWHO Warns. UN News.https:\/\/news.un.org\/en\/story\/2025\/02\/1160391."},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000003326"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.989231"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.21037\/gs.2019.06.05"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.21037\/abs\u201021\u2010146"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31818b7533"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100040\u20101"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100044\u20101788642"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/ebmed\u20102017\u2010110"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.1677"},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006529"},{"key":"e_1_2_15_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2020.10.098"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000794868.07051.b4"},{"key":"e_1_2_15_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000010470"},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004703.pub2"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2022.02.054"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000010343"},{"key":"e_1_2_15_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12282\u2010020\u201001076\u20101"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70160","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/micr.70160","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70160","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T09:07:04Z","timestamp":1773133624000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.70160"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":29,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/micr.70160"],"URL":"https:\/\/doi.org\/10.1002\/micr.70160","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-04-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70160"}}