First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema: a randomized pilot trial

Abstract

Advancements in reconstructive microsurgery have evolved into supermicrosurgery; connecting vessels with diameter between 0.3 and 0.8 mm for reconstruction of lymphatic flow and vascularized tissue transplantation. Supermicrosurgery is limited by the precision and dexterity of the surgeon's hands. Robot assistance can help overcome these human limitations, thereby enabling a breakthrough in supermicrosurgery. We report the first-inhuman study of robot-assisted supermicrosurgery using a dedicated microsurgical robotic platform. A prospective randomized pilot study is conducted comparing robot-assisted and manual supermicrosurgical lymphatico-venous anastomosis (LVA) in treating breast cancer-related lymphedema. We evaluate patient outcome at 1 and 3 months post surgery, duration of the surgery, and quality of the anastomosis. At 3 months, patient outcome improves. Furthermore, a steep decline in duration of time required to complete the anastomosis is observed in the robot-assisted group (33-16 min). Here, we report the feasibility of robot-assisted supermicrosurgical anastomosis in LVA, indicating promising results for the future of reconstructive supermicrosurgery.

Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review

“…20 Different approaches such as muscle flap harvesting, pedicle dissection, lymph-venous anastomosis have also been studied and reported. 16,21 However, the use of robotics in peripheral nerve reconstruction still lacks persuasive evidence. Therefore, in this study we aimed to review the literature and identify current clinical applications for robotic-assisted peripheral nerve reconstruction, and to evaluate the advantages and disadvantages to establish potential uses for the future.…”

Advances and Trends in Pediatric Minimally Invasive Surgery

“…Another approach is followed by Microsure (Eindhoven, The Netherlands), which developed the MUSA, a robot for open microsurgical procedures such as vessel or nerve anastomosis. This system has recently been evaluated in human gynecological surgery and appears to confer the feasibility of connecting vessels with a diameter between 0.3 and 0.8 mm for the reconstruction of lymphatic flow and vascularized tissue transplantation [ 119 , 120 , 121 ].…”

Development of a microsurgery‐assisted robot for high‐precision thread traction and tension control, and confirmation of its applicability

“…For macrosurgery, an important platform has been the Da Vinci Surgical System (Intuitive Surgical), 10–13 which is a teleoperation system comprising a master robot and a slave robot with two or three arms. Recently, microsurgical robotic technology has also been introduced wherein the surgeon manipulates the master robot, and the slave robot follows the motion accordingly in the surgical area 4,14 . This system has a great merit in assisting the performance of delicate tasks due to its features such as filtering the surgeon's tremor.…”

“…This surgical technology has been expanding its application range to maxillofacial surgery, head and neck surgery, gynaecology, ophthalmology, neurosurgery, plastic surgery and transplant surgery. [1][2][3] Recently, robot-assisted supermicrosurgery 4 and the high-performance video microscope 5 have also been introduced.…”

“…Recently, microsurgical robotic technology has also been introduced wherein the surgeon manipulates the master robot, and the slave robot follows the motion accordingly in the surgical area. 4,14 This system has a great merit in assisting the performance of delicate tasks due to its features such as filtering the surgeon's tremor.…”