{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:21:34Z","timestamp":1791598894244,"version":"4.3.4"},"reference-count":60,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Robotic deep inferior epigastric artery perforator (DIEP) flap surgery is a technique used for autologous breast reconstruction to maintain the integrity of the rectus abdominis muscle while also utilizing robotic assistance for flap harvest. This study assesses postoperative outcomes of patients undergoing robotic DIEP flap reconstruction through the measurement of postoperative pain, narcotics use, and antiemetic usage. Methods: A retrospective analysis was performed for patients undergoing robotic DIEP flap breast reconstruction between March 2024 and March 2025. Postoperative pain scores (1\u201310 scale), narcotics usage (measured in oral morphine equivalents), antiemetic usage, and complications were recorded. Patient outcomes were compared to a control group of 40 patients who had undergone abdominal-based free flap breast reconstruction. Results: Overall, 14 patients underwent robotic DIEP flap breast reconstruction, representing 24 breasts. The average patient age was 56.5 (range: 30\u201373). Ten patients underwent bilateral breast reconstruction, and four underwent unilateral breast reconstruction. The average length of stay postoperatively was 4.86 days (\u00b11.23 days), and the return of bowel function occurred in 1.29 days (\u00b10.47 days). No patients experienced an unplanned return to the OR or flap failure. Average pain scores on postoperative day 1 (POD1), 2 (POD2), and 3 (POD3) were 4.0 (\u00b10.6), 3.4 (\u00b10.6), and 2.93 (\u00b10.5), respectively. Average antiemetic usage totalled 1.25 doses (\u00b10.25). Average daily OME use was 27.7 (\u00b15.0) for POD1, 25.96 (\u00b16.3) for POD2, and 21.23 (\u00b17.11) for POD3. This averaged to a total hospital OME use of 74.9 (\u00b115.7) per patient. Patients undergoing robotic DIEP flap reconstruction required a significantly lower narcotics dosage, as well as a lower antiemetic dosage, during the first three days postoperatively compared to the control abdominal free flap group. Average pain scores in the robotic DIEP flap reconstruction patient group were also significantly decreased, specifically in POD2 and POD3. Conclusions: The robotic DIEP flap offers advantages in autologous breast reconstruction compared to other abdominal free flap reconstructive methods. In this limited retrospective study, the use of the robotic DIEP flap lowers chances of flap failure and complications, while also improving narcotics use, antiemetic use, and postoperative pain.<\/jats:p>","DOI":"10.3390\/jcm14155204","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T08:02:06Z","timestamp":1753257726000},"page":"5204","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Advancing DIEP Flap Surgery: Robotic-Assisted Harvest Reduces Pain and Narcotic Use"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5235-3527","authenticated-orcid":false,"given":"Chloe V.","family":"McCreery","sequence":"first","affiliation":[{"name":"John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, HI 96813, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Surgery, John A. Burns School of Medicine, University of Hawai\u2019I, Queen\u2019s University Tower, 1356 Lusitana Street, 6th Floor, Honolulu, HI 96813, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Deptula","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, HI 96813, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3661-3864","authenticated-orcid":false,"given":"Daniel","family":"Murariu","sequence":"additional","affiliation":[{"name":"John A. Burns School of Medicine, University of Hawai\u2019i, Honolulu, HI 96813, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"ref_1","unstructured":"(2025, March 30). Breast Cancer. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/breast-cancer."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1038\/s41591-025-03502-3","article-title":"Global patterns and trends in breast cancer incidence and mortality across 185 countries","volume":"31","author":"Kim","year":"2025","journal-title":"Nat. Med."},{"key":"ref_3","first-page":"477","article-title":"Breast cancer statistics 2024","volume":"74","author":"Giaquinto","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_4","first-page":"145","article-title":"New trends in breast cancer surgery: A therapeutic approach increasingly efficacy and respectful of the patient","volume":"36","author":"Franceschini","year":"2015","journal-title":"Il G. Chir. J. Ital. Assoc. Hosp. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"102012","DOI":"10.1016\/j.tranon.2024.102012","article-title":"Comparative dosimetric study of h-IMRT and VMAT plans for breast cancer after breast-conserving surgery","volume":"47","author":"Zhang","year":"2024","journal-title":"Transl. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1056\/NEJMoa050518","article-title":"Effect of screening and adjuvant therapy on mortality from breast cancer","volume":"353","author":"Berry","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1200\/JCO.2004.04.188","article-title":"Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: The PROSE Study Group","volume":"22","author":"Rebbeck","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"vi31","DOI":"10.1093\/annonc\/mdr373","article-title":"BRCA in breast cancer: ESMO Clinical Practice Guidelines","volume":"22","author":"Rubio","year":"2011","journal-title":"Ann Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.4103\/ajm.AJM_21_18","article-title":"Prophylactic mastectomy for the prevention of breast cancer: Review of the literature","volume":"8","author":"Alaofi","year":"2018","journal-title":"Avicenna J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s10549-017-4476-1","article-title":"The expected benefit of preventive mastectomy on breast cancer incidence and mortality in BRCA mutation carriers, by age at mastectomy","volume":"167","author":"Giannakeas","year":"2018","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3437","DOI":"10.1200\/JCO.2009.27.6774","article-title":"Are mastectomy rates really increasing in the United States?","volume":"28","author":"Habermann","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Golara, A., Koz\u0142owski, M., Lubikowski, J., and Cymbaluk-P\u0142oska, A. (2024). Types of breast cancer surgery and breast reconstruction. Cancers, 16.","DOI":"10.3390\/cancers16183212"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1001\/jamasurg.2020.6664","article-title":"Bilateral mastectomy in women with unilateral breast cancer: A review","volume":"156","author":"Lim","year":"2021","journal-title":"JAMA Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Xiong, Z., Yang, L., Deng, G., Huang, X., Li, X., Xie, X., Wang, J., Shuang, Z., and Wang, X. (2018). Patterns of occurrence and outcomes of contralateral breast cancer: Analysis of SEER data. J. Clin. Med., 7.","DOI":"10.3390\/jcm7060133"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.canep.2016.02.011","article-title":"Trends in use of contralateral prophylactic mastectomy by racial\/ethnic group and ER\/PR status among patients with breast cancer: A SEER population-based study","volume":"42","author":"Brown","year":"2016","journal-title":"Cancer Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.breast.2014.06.012","article-title":"Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: A prospective controlled study","volume":"23","author":"Aerts","year":"2014","journal-title":"Breast"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e883","DOI":"10.6061\/clinics\/2019\/e883","article-title":"Sexuality, depression and body image after breast reconstruction","volume":"74","author":"Archangelo","year":"2019","journal-title":"Clinics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1016\/j.bjps.2016.06.004","article-title":"Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: A case-controlled cohort study","volume":"69","author":"Howes","year":"2016","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"19","DOI":"10.21037\/abs-23-33","article-title":"The psychological impacts of post-mastectomy breast reconstruction: A systematic review","volume":"8","author":"Roy","year":"2024","journal-title":"Ann. Breast Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"14","DOI":"10.21037\/abs-20-146","article-title":"Breast reinnervation\u2014The next frontier in autologous breast reconstruction: A review of early results","volume":"6","author":"Carrau","year":"2022","journal-title":"Ann. Breast Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e72","DOI":"10.1097\/GOX.0000000000000008","article-title":"Breast reinnervation: DIEP neurotization using the third anterior intercostal nerve","volume":"1","author":"Spiegel","year":"2013","journal-title":"Plast. Reconstr. Surg. Glob. Open."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/PRS.0000000000001747","article-title":"Comparison of Outcomes following Autologous Breast Reconstruction Using the DIEP and Pedicled TRAM Flaps: A 12-Year Clinical Retrospective Study and Literature Review","volume":"138","author":"Knox","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1097\/PRS.0b013e3181f02520","article-title":"A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: Part I. Unilateral reconstruction","volume":"126","author":"Selber","year":"2010","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1016\/j.bjps.2020.12.044","article-title":"Abdominal weakness, bulge, or hernia after DIEP flaps: An algorithm of management, prevention, and surgical repair with classification","volume":"74","author":"Haddock","year":"2021","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1097\/01.prs.0000210679.77449.7d","article-title":"DIEP and pedicled TRAM flaps: A comparison of outcomes","volume":"117","author":"Garvey","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lee, M.J., Won, J., Song, S.Y., Park, H.S., Kim, J.Y., Shin, H.J., Kwon, Y.I., Lee, D.W., and Kim, N.Y. (2022). Clinical outcomes following robotic versus conventional DIEP flap in breast reconstruction: A retrospective matched study. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.989231"},{"key":"ref_27","first-page":"277","article-title":"A New Era in Perforator Flap Surgery for Breast Reconstruction: A Comparative Study of Robotic versus Standard Harvest of Bilateral Deep Inferior Epigastric Artery Perforator Flaps","volume":"41","author":"Moreira","year":"2024","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1007\/s11701-020-01168-2","article-title":"Robotic versus open oncological gastric surgery in the elderly: A propensity score-matched analysis","volume":"15","author":"Garbarino","year":"2021","journal-title":"J. Robot. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Novellis, P., Maisonneuve, P., Dieci, E., Voulaz, E., Bottoni, E., Stefano, S.D., Solinas, M., Testori, A., Cariboni, U., and Alloisio, M. (2021). Quality of Life, Postoperative Pain, and Lymph Node Dissection in a Robotic Approach Compared to VATS and OPEN for Early Stage Lung Cancer. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081687"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1097\/SLA.0000000000003915","article-title":"Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews","volume":"273","author":"Muaddi","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5861","DOI":"10.1245\/s10434-022-11836-2","article-title":"Analysis of Opioid Use in Patients Undergoing Open Versus Robotic Gastrectomy","volume":"29","author":"Hirata","year":"2022","journal-title":"Ann. Surg. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s00384-017-2943-0","article-title":"Perioperative pain after robot-assisted versus laparoscopic rectal resection","volume":"33","author":"Tolstrup","year":"2018","journal-title":"Int. J. Color. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.surg.2023.08.064","article-title":"Inpatient opioid use and pain control after robotic versus laparoscopic sleeve gastrectomy","volume":"175","author":"Saleh","year":"2024","journal-title":"Surgery"},{"key":"ref_34","first-page":"e52695","article-title":"Revolutionising breast surgery: A comprehensive review of robotic innovations in breast surgery and reconstruction","volume":"16","author":"Jain","year":"2024","journal-title":"Cureus"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"601","DOI":"10.5694\/j.1326-5377.2002.tb04593.x","article-title":"Does cosmetic surgery improve psychosocial wellbeing?","volume":"176","author":"Castle","year":"2002","journal-title":"Med. J. Aust."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1111\/jocd.15683","article-title":"Bibliometric analysis of global research on breast reconstruction after mastectomy for breast cancer from 2011 to 2021","volume":"22","author":"Zhang","year":"2023","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"767","DOI":"10.21037\/gs-22-540","article-title":"Bibliometric analysis of robotic surgery research in breast cancer conducted between 2008 and 2022","volume":"12","author":"Ma","year":"2023","journal-title":"Gland Surg."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Yusufov, S., Startseva, O., Khalfaoui, S., Zhigailova, E., Gabriyanchik, M., Manasherova, D., Meskhi, K., and Reshetov, I. (2025). Robot-assisted versus conventional harvesting of DIEP and latissimus Dorsi flaps for breast reconstruction in post-mastectomy women: A systematic review and meta-analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14030744"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s11701-024-01913-x","article-title":"Surgical outcomes of robotic versus conventional autologous breast reconstruction: A systematic review and meta-analysis","volume":"18","author":"Elameen","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S374","DOI":"10.1097\/SAP.0000000000003084","article-title":"Minimizing postoperative pain in autologous breast reconstruction with the omental fat-augmented free flap","volume":"88","author":"Deptula","year":"2022","journal-title":"Ann. Plast. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1097\/SAP.0000000000000873","article-title":"Transversus abdominis plane block and free flap abdominal tissue breast reconstruction: Is there a true reduction in postoperative narcotic use?","volume":"78","author":"Hunter","year":"2017","journal-title":"Ann. Plast. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.bjps.2023.07.005","article-title":"Outcomes of DIEP flap reconstruction after pelvic cancer surgery: A retrospective multicenter case series","volume":"85","author":"Pividori","year":"2023","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.ygyno.2015.06.031","article-title":"Vaginal reconstruction with pedicled vertical deep inferior epigastric perforator flap (diep) after pelvic exenteration. A consecutive case series","volume":"138","author":"Ferron","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1055\/s-0043-1777076","article-title":"DIEP flap for head and neck reconstruction: An underutilized option!","volume":"57","author":"Jaiswal","year":"2024","journal-title":"Indian. J. Plast. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.bjps.2004.06.003","article-title":"The versatile DIEP flap: Its use in lower extremity reconstruction","volume":"58","author":"Blondeel","year":"2005","journal-title":"Br. J. Plast. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/PRS.0000000000006529","article-title":"The robotic DIEP flap","volume":"145","author":"Selber","year":"2020","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1111\/tbj.13349","article-title":"Postoperative analgesia after microsurgical breast reconstruction using liposomal bupivacaine (Exparel)","volume":"25","author":"Momeni","year":"2019","journal-title":"Breast J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1001\/jamasurg.2020.3623","article-title":"Preoperative opioid use and mortality after minor outpatient surgery","volume":"155","author":"Santosa","year":"2020","journal-title":"JAMA Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"613e","DOI":"10.1097\/PRS.0000000000003742","article-title":"Managing opioid addiction risk in plastic surgery during the perioperative period","volume":"140","author":"Demsey","year":"2017","journal-title":"Plast Reconstr. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1213\/ANE.0000000000002458","article-title":"Chronic opioid use after surgery: Implications for perioperative management in the face of the opioid epidemic","volume":"125","author":"Hah","year":"2017","journal-title":"Anesth. Analg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1093\/bja\/78.5.606","article-title":"Multimodal approach to control postoperative pathophysiology and rehabilitation","volume":"78","author":"Kehlet","year":"1997","journal-title":"Br. J. Anaesth."},{"key":"ref_52","first-page":"A09220536","article-title":"Enhanced recovery after surgery","volume":"69","author":"Kehlet","year":"2022","journal-title":"Dan. Med. J."},{"key":"ref_53","unstructured":"Guidelines-ERAS\u00ae Society (2025, April 03). ERAS\u00ae Society. Available online: https:\/\/erassociety.org\/guidelines\/."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1097\/PRS.0000000000005300","article-title":"Enhanced Recovery after Surgery Pathway for Microsurgical Breast Reconstruction: A Systematic Review and Meta-Analysis","volume":"143","author":"Sebai","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1016\/j.surg.2023.02.016","article-title":"National analysis of cost disparities in robotic-assisted versus laparoscopic abdominal operations","volume":"173","author":"Ng","year":"2023","journal-title":"Surgery"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s11701-024-01987-7","article-title":"The emerging role of robotics in plastic and reconstructive surgery: A systematic review and meta-analysis","volume":"18","author":"Awad","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"590e","DOI":"10.1097\/PRS.0000000000010470","article-title":"Novel Port Placement in Robot-Assisted DIEP Flap Harvest Improves Visibility and Bilateral DIEP Access: Early Controlled Cohort Study","volume":"152","author":"Tsai","year":"2023","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Heidekrueger, P.I., Moellhoff, N., Horch, R.E., Lohmeyer, J.A., Marx, M., Heitmann, C., Fansa, H., Geenen, M., Gabka, C.J., and Handstein, S. (2021). Overall complication rates of DIEP flap breast reconstructions in Germany\u2014A multi-center analysis based on the DGPR\u00c4C prospective national online registry for microsurgical breast reconstructions. J. Clin. Med., 10.","DOI":"10.3390\/jcm10051016"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.bjps.2024.02.059","article-title":"Secondary solution for breast reconstruction following total DIEP flap loss: A single-center experience after 3270 DIEP flaps","volume":"92","author":"Musmann","year":"2024","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"566e","DOI":"10.1097\/PRS.0000000000010343","article-title":"Predictors of complications in autologous breast reconstruction using DIEP flaps: Implications for management","volume":"152","author":"Wu","year":"2023","journal-title":"Plast. Reconstr. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5204\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:14:18Z","timestamp":1760033658000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5204"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,23]]},"references-count":60,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14155204"],"URL":"https:\/\/doi.org\/10.3390\/jcm14155204","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,23]]}}}