Robotic-Assisted Microsurgery and Its Future in Plastic Surgery

Aitzetmüller, Matthias M.; Klietz, Marie-Luise; Dermietzel, Alexander; Hirsch, Tobias; Kückelhaus, Maximilian

doi:10.3390/jcm11123378

Cited by 23 publications

(31 citation statements)

References 34 publications

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“…In der plastischen und rekonstruktiven Chirurgie erfolgte die erste roboterunterstützte mikrochirurgische Anastomose 2007 mit dem Da-Vinci-System – der Eingriff nahm noch über eine Stunde in Anspruch [ 16 ]. Seither steigen die Anwendungen von Robotersystemen auch in der plastischen Chirurgie stetig und reichen von mikrochirurgischen Eingriffen für autologe Brustrekonstruktionen bis hin zu supermikrochirurgischen Operationen im Rahmen der rekonstruktiven Lymphchirurgie [ 1 , 6 , 9 , 13 ].…”

Section: Robotersysteme In Der Mikrochirurgieunclassified

Robotik in der plastischen Chirurgie

et al. 2023

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ZusammenfassungIn den letzten Jahren haben speziell für die Mikrochirurgie entwickelte Roboter das Anwendungsgebiet robotisch assistierter Operationen auch in der plastisch-rekonstruktiven Chirurgie erweitert. Derzeit gibt es zwei Mikrochirurgierobotersysteme, welche in der plastischen Chirurgie eingesetzt werden. Beide Systeme verfügen über Technologien zur Tremorreduzierung und Bewegungsskalierung, wodurch die Präzision und Geschicklichkeit des Chirurgen optimiert werden sollen. In der Klinik für Plastische Chirurgie und Handchirurgie des Universitätsspitals Zürich wird das Symani Surgical System® bereits bei vielen mikro- und supermikrochirurgischen Operationen, unter anderem bei autologen Brustrekonstruktionen, Nerventransfers und im Besonderen in der rekonstruktiven Lymphchirurgie, eingesetzt. Trotz spezieller technischer Herausforderungen, beispielsweise einem fehlenden haptischen Feedback, überwiegen nach entsprechendem Training des Mikrochirurgen die Vorteile, dazu zählen insbesondere kleinere Operationszugänge für anatomisch tiefe Strukturen und eine Verbesserung der chirurgischen Präzision.

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Section: Robotersysteme In Der Mikrochirurgieunclassified

Robotik in der plastischen Chirurgie

et al. 2023

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“…for the microsurgeon 13 . Training with devices for robotic assistance is essential to draw conclusions about their potential clinical utility in microsurgical applications.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…As this system is operated by a telemetric control, the combination with an exoscope or robotic microscope potentially offers improved ergonomics for the microsurgeon. 13 Training with devices for robotic assistance is essential to draw conclusions about their potential clinical utility in microsurgical applications. Therefore, this study describes the training of experienced microsurgeons and complete novices in microsurgery and their respective learning curves using such a combination of a robotic microsurgical system with an exoscope.…”

mentioning

confidence: 99%

Combined Application of a Novel Robotic System and Exoscope for Microsurgical Anastomoses: Preclinical Performance

Wessel,

Wendenburg,

Gorji

et al. 2023

J Reconstr Microsurg Open

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Background: The concept of robotic microsurgery is becoming increasingly known as several robotic systems tailored to the specific needs of microsurgery are being introduced. Training with these devices is essential to draw conclusions about their potential clinical utility. This study describes the training and learning curve of experienced microsurgeons and complete novices using such a robotic surgical system in combination with an exoscope. Methods: Four experienced microsurgeons and three complete novices performed a total of 62 manual and robot-assisted anastomoses. The time for anastomosis completion, surgeon's satisfaction with the anastomosis and with the robotic system were recorded. The anastomoses’ quality was assessed using the Structured Assessment of Microsurgery Skills (SAMS) and the Anastomosis Lapse Index (ALI). The Rapid Entire Body Assessment (REBA) was used for ergonomics evaluation. Results: All expert microsurgeons and novices improved their performance during training. The average anastomosis time decreased significantly while satisfaction with the anastomosis and robotic system increased significantly over time. Multiple SAMS score parameters increased significantly throughout robotic but not manual training and the ALI score demonstrated more errors in the manual group. The REBA score displayed a significantly lower risk for musculoskeletal disorders in the robotic group. Conclusion: Currently, the first clinical applications of robotic surgical systems specifically designed for microsurgery are being reported. The introduction of such systems into clinical practice can be expected to have a steep learning curve, as demonstrated in our study. Meanwhile, robotic systems for microsurgical procedures may hold great potential for improvement of surgical quality and ergonomics.

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“…4,5 The field of plastic surgery, however, has taken more time to integrate robotic-assisted surgery into routine procedures. [6][7][8] Robotic-assisted surgery has gained popularity in oncologic and reconstructive breast surgery, with the development of robotic-assisted procedures such as nipple-sparing mastectomy (NSM), latissimus dorsi muscle flap harvest, deep inferior epigastric perforator (DIEP) flap breast reconstruction, and microsurgery with arterial and venous anastomosis being done with robotic assistance routinely. 2 With the advancements in the field of robotic plastic surgery, it will soon be possible for patients to undergo an extirpative breast surgery with immediate reconstruction utilizing robotic assistance.…”

Section: Introductionmentioning

confidence: 99%

The Full Continuum of Robotic Breast Surgery: Robotic-assisted Mastectomy, Robotic DIEP Flap, and Robotic Supermicrosurgery

Tanna,

Sugiyama,

Smith

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Summary: In recent years, robotic surgery has rapidly expanded to improve surgical outcomes in a variety of surgical subspecialties. Although plastic surgery has taken longer to integrate robotic surgery into practice, the advantages of robotic-assisted surgery, including improved visualization and resolution, minimally invasive approaches, and the ability to surpass human precision and scale, have driven its more recent adoption into plastic surgery. Currently, procedures performed with robotic assistance that are considered part of the continuum of surgical treatment of breast cancer include robotic-assisted nipple-sparing mastectomy, reconstruction with the robotic latissimus dorsi flap or the deep inferior epigastric artery perforator flap, and robotic microsurgery for the flap anastomosis and/or the surgical treatment of lymphedema. The authors provide an overview of robotic surgery and how it has been integrated into the field of plastic surgery, as well as a review of the most common procedures within the field where robotic assistance can be incorporated: nipple-sparing mastectomy, robotic latissimus flap, robotic deep inferior epigastric artery perforator flap breast reconstruction, and microvascular anastomoses.

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Robotic-Assisted Microsurgery and Its Future in Plastic Surgery

Cited by 23 publications

References 34 publications

Robotik in der plastischen Chirurgie

Robotik in der plastischen Chirurgie

Combined Application of a Novel Robotic System and Exoscope for Microsurgical Anastomoses: Preclinical Performance

The Full Continuum of Robotic Breast Surgery: Robotic-assisted Mastectomy, Robotic DIEP Flap, and Robotic Supermicrosurgery

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