Using a Microsurgical Robotic Platform for In-flap Anastomosis in Autologous Bipedicular Breast Reconstruction

Autologous microsurgical breast reconstruction has become a standard of care. As techniques become more individualized and aim for less-invasive approaches, vessels ever smaller in diameter are considered for flap anastomosis. Robot-assisted surgery has great potential to reduce tremor and enhance precise motion. The Symani Surgical System (Medical Microinstruments, Inc., Wilmington, Del.) is a robotic platform designed for microsurgery. It was used for a microsurgical in-flap anastomosis of a bipedicular deep inferior epigastric artery flap for unilateral breast reconstruction. The procedure included fully robot-assisted anastomoses with significant size mismatches using a 3D-exoscope for magnification. Arterial and venous anastomoses were entirely robot-assisted completed in 23 minutes (seven stitches) and 28 minutes (eight stitches) using 9/0 nylon sutures. The intra- and postoperative course was uneventful. This robotic platform facilitates in-flap anastomoses of small vessels by increasing the precision of instrument handling and eliminating tremor. The combination of robotic platforms and exoscopes provides superior ergonomics in comparison with conventional (super)microsurgery. We expect robotic platforms to play a significant role in modern microsurgical breast reconstruction.