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Early Experience Using a New Robotic Microsurgical System for Lymphatic Surgery.

Nicole Lindenblatt1, Lisanne Grünherz1, Anna Wang1

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This study demonstrates the feasibility and safety of robotic microsurgery for lymphatic reconstruction, showing high accuracy in vessel anastomosis. Further research is needed to explore its full potential in complex reconstructive procedures.

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Area of Science:

  • Microsurgery
  • Robotic Surgery
  • Vascular Surgery

Background:

  • Robotic microsurgery offers potential advantages for reconstructive procedures.
  • Lymphatic reconstruction often involves delicate microanastomoses.

Purpose of the Study:

  • To report the first-in-human application of the Symani surgical system for lymphatic reconstruction.
  • To evaluate the feasibility, safety, and outcomes of robot-assisted lympho-venous and arterial anastomoses.

Main Methods:

  • Ten robot-assisted anastomoses were performed in five patients for lymphatic reconstruction.
  • Procedures included lympho-venous anastomoses and free vascularized lymph node transfer.
  • Motion scaling was set to 10x, with visualization via 3D system or microscope.

Main Results:

  • All anastomoses were patent, confirmed by indocyanine green (ICG) angiography.
  • Initial anastomosis times were longer with the robot, but duration decreased with experience.
  • The system demonstrated high accuracy, particularly with small, fragile vessels or size mismatches.

Conclusions:

  • Robotic-assisted lymphatic surgery is feasible and safe.
  • Challenges include the lack of tactile feedback, though a "see-feel" sensation was developed.
  • Future studies with larger cohorts and diverse surgeon experience are required to confirm the potential of robotics in microsurgery.