Conference Coverage

Robotic VRAM Flap Reconstruction Reduces Donor Site Hernias in Abdominoperineal Resection

Miranda Manier, BA

Key Highlights

  • Robotic vertical rectus abdominis myocutaneous (VRAM) harvest during abdominoperineal resection reduced donor site hernia risk by 69% compared with conventional open techniques.
  • Donor site hernia occurred in 23.5% of patients, with only one requiring operative repair.
  • Perineal wound complications, including wound dehiscence (23.5%) and infection (17.6%), were comparable to published data for open VRAM.
  • Diabetes and adjuvant chemotherapy independently predicted higher rates of wound complications.

Robotic vertical rectus abdominis myocutaneous (VRAM) flap harvest for abdominoperineal resection (APR) demonstrated significantly lower abdominal donor site hernia rates compared with conventional open techniques. In this study, patients undergoing robotic APR with VRAM were 69% less likely to develop a donor site hernia, while perineal wound complications remained comparable to those seen with traditional methods.

APR for low rectal and anal cancers presents a reconstructive challenge, particularly in patients who have received neoadjuvant chemoradiation. Traditional VRAM flaps are widely used to manage perineal defects, but they require large abdominal incisions, which contribute to donor site hernia rates as high as 50%. Robotic VRAM flap harvest offers a minimally invasive alternative by preserving the anterior rectus fascia, which may reduce hernia risk without compromising the effectiveness of perineal reconstruction. This study was conducted to evaluate outcomes of robotic VRAM harvest and to compare complication rates to those reported for conventional open approaches.

Stephanie Jensen and colleagues performed a retrospective review of all patients who underwent robotic APR with VRAM flap harvest by a single surgeon between 2021 and 2024. Demographics, operative data, and postoperative complications were collected. Donor site hernia was diagnosed with CT imaging, and outcomes were compared with published rates for open VRAM harvest. Statistical analyses included T-tests, Mann-Whitney U tests, Fisher’s Exact tests, Shapiro-Wilk tests, and logistic regression modeling to adjust for covariates.

Seventeen patients were included in the study, all of whom had received neoadjuvant chemoradiation. Donor site hernia was diagnosed in 23.5% of patients, with only one case requiring operative repair. No perineal hernias occurred. Perineal wound dehiscence developed in 23.5% of patients and was generally managed with wound care, while perineal infections occurred in 17.6% of cases. Overall, 23.5% of patients required a return to the operating room. On multivariate analysis, diabetes was significantly associated with a higher risk of wound infection (P = .03), and adjuvant chemotherapy was associated with an increased risk of wound dehiscence (P = .02). Compared with published rates of open VRAM harvest, patients who underwent robotic harvest were 69% less likely to develop a donor site hernia (OR 0.311; P = .049).

“Robotic APR with VRAM reduces donor site hernia rates compared to traditional harvesting techniques, likely due to anterior rectus fascia preservation,” Jensen and colleagues concluded. “This minimally invasive approach maintains similar perineal reconstruction complication rates while improving donor site outcomes. Robotic VRAM has the potential to redefine standards in APR reconstruction and warrants further discussion, particularly due to its ability to improve patient care.”

Reference
Jensen S, Kogan S, Sanderfer V, Teng E, Zeng E. Robotic VRAM flap reconstruction in APR: a promising approach to reduce abdominal donor site complications. Poster presented at: American Society of Plastic Surgeons 94th Annual Meeting; October 9-12, 2025; New Orleans, LA. Accessed September 22, 2025. https://www.plasticsurgerythemeeting.com/