Robotic-Assisted DIEP Flap Harvest: A Call for Balanced Discussion of Surgical Risk

We commend Choe et al. for their technically detailed report on robotic-assisted deep inferior epigastric perforator (DIEP) flap harvest. While recognizing the promise of robotic surgery in microsurgical applications, we believe a more critical evaluation of the intraabdominal approach is warranted. The technique's emphasis on reduced fascial incision length must be weighed against underexplored risks, including potential intraabdominal complications, peritoneal entry, adhesions, increased hernia risk from multiple port sites, and the physiologic effects of gas insufflation. Additionally, longer ischemia times and total operative duration should be considered when assessing overall surgical benefit. This letter highlights key concerns and encourages a balanced discussion on the true trade-offs of robotic-assisted DIEP flap harvest within the evolving field of reconstructive microsurgery.